Breuckmann Frank, Hochadel Matthias, Münzel Thomas, Giannitsis Evangelos, Voigtländer Thomas, Senges Jochen
From the *Department of Cardiology, Arnsberg Medical Center, Arnsberg; †Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg; ‡2nd Department of Medicine, Johannes Gutenberg-University Mainz, Mainz; §3rd Department of Medicine, University Hospital Heidelberg, Heidelberg; and ¶Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
Crit Pathw Cardiol. 2015 Mar;14(1):7-11. doi: 10.1097/HPC.0000000000000032.
Management of acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) and unstable angina pectoris (UAP) remains challenging. The study aimed to analyze the current management of UAP patients in German chest pain units focussing on the different time lines of invasive strategy.
A total of 1400 UAP patients admitted to a certified chest pain unit were enrolled. Analyses of high-risk criteria with indication for invasive management and of 3-month clinical outcomes were performed by subgrouping UAP patients to immediate and early invasive (<8 hours), early elective invasive (8-24 hours), late elective invasive (24-72 hours) strategy, and without percutaneous coronary intervention (PCI).
Coronary angiography was performed in 60.6% of the UAP patients, whereas PCI was necessary in 37%. Only 1.4% of the UAP patients obtained immediate PCI within the first 120 minutes. In 16.9%, patients received PCI within the first day of hospitalization or even within the first 8 hours after admission in another 7.7%, although the Global Registry of Acute Coronary Events (GRACE) score at admission was below 140. In the remaining 12.4% of the UAP patients, PCI was performed within 24-72 hours after admission. Those patients exhibited a higher prevalence of secondary risk markers than those with conservative treatment regimen.
To date, almost two-third of UAP patients at intermediate to high risk receive rapid invasive regimen within the first 24 hours after admission. Oncoming studies will have to analyze its overall guideline-adherence and resulting differences in major adverse events.
急性冠状动脉综合征非持续性ST段抬高（NSTE-ACS）和不稳定型心绞痛（UAP）的管理仍然具有挑战性。本研究旨在分析德国胸痛单元中UAP患者的当前管理情况，重点关注侵入性策略的不同时间线。
共纳入1400例入住认证胸痛单元的UAP患者。通过将UAP患者分为即刻和早期侵入性（<8小时）、早期选择性侵入性（8-24小时）、晚期选择性侵入性（24-72小时）策略以及未进行经皮冠状动脉介入治疗（PCI）的亚组，对具有侵入性管理指征的高危标准和3个月临床结局进行分析。
60.6%的UAP患者接受了冠状动脉造影，而37%的患者需要进行PCI。只有1.4%的UAP患者在最初120分钟内接受了即刻PCI。16.9%的患者在住院第一天内接受了PCI，另有7.7%的患者在入院后8小时内接受了PCI，尽管入院时全球急性冠状动脉事件注册研究（GRACE）评分低于140。在其余12.4%的UAP患者中，PCI在入院后24-72小时内进行。这些患者的次要风险标志物患病率高于采用保守治疗方案的患者。
迄今为止，近三分之二的中高危UAP患者在入院后24小时内接受了快速侵入性治疗方案。后续研究将不得不分析其总体指南依从性以及由此导致的主要不良事件差异。
