Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni, 85, 50134, Firenze, Florence, Italy.
Intern Emerg Med. 2013 Mar;8(2):129-39. doi: 10.1007/s11739-011-0596-5. Epub 2011 Jun 7.
In non-ST-elevation acute coronary syndromes (ACS), an early invasive strategy is recommended for middle/high-risk patients; however, the optimal timing for coronary angiography is still debated. The aim of this study was to evaluate the prognostic implications of the time of angiography in ACS patients treated in accord with an early invasive strategy. We analyzed the relationship between the time of angiography and outcomes at follow-up in 517 ACS patients, of whom 482 were revascularized with percutaneous coronary intervention (PCI) (86.9%) or coronary artery by-pass graft (13.1%). We also evaluated the influence of clinical, biohumoral and angiographic variables on the patients' outcomes at follow-up. Among patients submitted to angiography at different time intervals from both hospital admission and symptom onset, significant differences neither in mortality nor in cardiac ischemic events at follow-up were observed. At univariate analysis, complete versus partial revascularization, longer hospital stay, higher TIMI risk score, diabetes mellitus, higher discharge creatinine and admission anemia were associated with mortality and cardiac ischemic events at follow-up; a lower left ventricular ejection fraction was associated with mortality; higher peak troponin I and previous PCI were associated with cardiac ischemic events at follow-up. At multivariate analysis longer hospital stay, higher discharge creatinine levels, and previous PCI were independent predictors of cardiac ischemic events at follow-up. Our evaluation in ACS patients treated with an early invasive strategy does not support the concept that angiography should be performed as soon as possible after symptom onset or hospital admission. Rather, an unfavorable long-term outcome is influenced principally by the clinical complexity of patients.
在非 ST 段抬高型急性冠状动脉综合征（ACS）中，建议对中/高危患者采用早期侵入性策略；然而，冠状动脉造影的最佳时机仍存在争议。本研究旨在评估根据早期侵入性策略治疗的 ACS 患者冠状动脉造影时间对预后的影响。我们分析了 517 例 ACS 患者的冠状动脉造影时间与随访结果之间的关系，其中 482 例患者接受经皮冠状动脉介入治疗（PCI）（86.9%）或冠状动脉旁路移植术（CABG）（13.1%）血运重建。我们还评估了临床、生物化学和血管造影变量对患者随访结果的影响。在从入院和症状发作开始的不同时间间隔进行血管造影的患者中，在随访期间死亡率和心脏缺血事件方面均未观察到显著差异。单因素分析显示，完全与部分血运重建、住院时间较长、较高的 TIMI 风险评分、糖尿病、较高的出院肌酐和入院贫血与随访期间的死亡率和心脏缺血事件相关；较低的左心室射血分数与死亡率相关；较高的肌钙蛋白 I 峰值和先前的 PCI 与随访期间的心脏缺血事件相关。多因素分析显示，住院时间较长、出院肌酐水平较高和先前的 PCI 是随访期间心脏缺血事件的独立预测因素。我们对接受早期侵入性策略治疗的 ACS 患者的评估不支持这样一种观点，即血管造影应在症状发作或入院后尽快进行。相反，不良的长期预后主要受患者临床复杂性的影响。
