Walkowicz Wojciech, Gasior Zbigniew, Dabek Józefa
Slaski Uniwersytet Medyczny w Katowicach, Katedra i Klinika Kardiologii.
Pol Merkur Lekarski. 2011 Jan;30(175):10-8.
Development of interventional cadriology is cause of increasing number of acute coronary syndrome (ACS) patients with prior revascularization procedures in the past.
To evaluate the clinical feature of ACS patients with and without prior revascularization procedures and to compare in-hospital and long-term outcome following percutaneous coronary intervention (PCI) in these groups.
There were 325 ACS consecutive patients included to the study who underwent PCI procedures. There were 175 patients after PCI or coronary artery by-pass grafting in the past. Control group consisted of 150 subjects with ACS with no history of PCI procedures. We analyzed baseline characteristic as well as the inhospital, 30- and 180-day outcomes.
The baseline characteristic revealed higher rate of patients with heart failure in case-history (18.0% vs. 26.9%, p = 0.03), diabetes (16.0% vs. 25.1%, p = 0.04), and multi-vessels coronary disease (85.2% vs. 60.6%, p = 0.003) in the subgroup of prior revascularization. The rate of non-STEMI was higher (28.0% vs. 40.6%, p = 0.02) and the rate of STEMI was lower (47.4% vs. 63.3%, p = 0.004) as a form of ACS in previously revascularized subjects. The analysis of inhospital outcome revealed significantly longer time of hospitalization of the patients with prior revascularization (7.7 +/- 4.6 vs. 5.4 +/- 4.1, p < 0.0001). There were no significant differences in clinical characteristics at 6-months after ACS.
Patients undergoing PCI in ACS with prior revascularization procedures are characterized by a higher level of atherosclerosis risk factors, more advanced changes in coronary arteries and higher NSTEMI occurance than ACS patients without PCI history. Baseline and long-term results of revascularization, frequency and nature of complications are comparable in both groups, but length of hospitalization period and significantly longer in patients with revascularization in the past.
过去介入心脏病学的发展导致既往接受过血运重建术的急性冠状动脉综合征（ACS）患者数量增加。
评估有和没有既往血运重建术的ACS患者的临床特征，并比较这些组在经皮冠状动脉介入治疗（PCI）后的住院和长期结局。
325例连续接受PCI手术的ACS患者纳入本研究。其中175例患者既往接受过PCI或冠状动脉旁路移植术。对照组由150例无PCI手术史的ACS患者组成。我们分析了基线特征以及住院、30天和180天的结局。
基线特征显示，既往血运重建亚组中，有心力衰竭病史的患者比例更高（18.0%对26.9%，p = 0.03）、糖尿病患者比例更高（16.0%对25.1%，p = 0.04）以及多支冠状动脉疾病患者比例更高（85.2%对60.6%，p = 0.003）。在既往血运重建的患者中，作为ACS的一种形式，非ST段抬高型心肌梗死（NSTEMI）的发生率更高（28.0%对40.6%，p = 0.02），ST段抬高型心肌梗死（STEMI）的发生率更低（47.4%对63.3%，p = 0.004）。住院结局分析显示，既往血运重建的患者住院时间明显更长（7.7±4.6对5.4±4.1，p < 0.0001）。ACS后6个月时的临床特征无显著差异。
与无PCI病史的ACS患者相比，既往接受过血运重建术的ACS患者接受PCI治疗的特点是动脉粥样硬化危险因素水平更高、冠状动脉病变更严重以及NSTEMI发生率更高。两组血运重建的基线和长期结果、并发症的发生率和性质相当，但住院时间长度在既往有血运重建的患者中明显更长。
