Department of Cardiology, Nagoya University Hospital, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiol. 2019 Oct;74(4):320-327. doi: 10.1016/j.jjcc.2019.03.006.
Although there are guidelines that recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and concomitant congestive heart failure (CHF), optimal timing of the invasive strategy remains controversial.
Among 2045 patients who were admitted owing to NSTE-ACS or CHF, 300 presented with NSTE-ACS and concomitant CHF. Of the 300 patients, we enrolled 160 patients for whom coronary angiography (CAG) during their hospital stay was planned at the time of admission; 64 of these patients were classified into the early invasive group (<24h) and 96 were classified to the delayed invasive group (≥24h). We evaluated the primary outcome which was defined as a composite of cardiac mortality, life-threatening arrhythmia, and non-fatal myocardial infarction (MI).
The median time between presentation and CAG was 2h in the early invasive group and 240h in the delayed group. During follow-up, the primary outcome was significantly lower in the early invasive group [hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.30-0.87; p=0.01]. After the adjustment of confounding factors, the primary outcome was significantly less frequent (HR, 0.44; 95% CI, 0.23-0.78; p=0.004) in the early invasive group compared to the delayed invasive group.
The early invasive strategy was associated with a lower risk of the composite primary outcome in the long-term follow-up of patients with NSTE-ACS and concomitant CHF.
尽管有指南建议对非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）合并充血性心力衰竭（CHF）患者采取早期侵入性策略，但最佳侵入性策略时机仍存在争议。
在因 NSTE-ACS 或 CHF 住院的 2045 例患者中，有 300 例同时患有 NSTE-ACS 和 CHF。在这 300 例患者中，我们纳入了 160 例计划在住院期间进行冠状动脉造影（CAG）的患者；其中 64 例患者被分为早期侵入组（<24h），96 例患者被分为延迟侵入组（≥24h）。我们评估了主要终点，定义为心脏性死亡、危及生命的心律失常和非致命性心肌梗死（MI）的复合结果。
早期侵入组的中位 CAG 时间为入院后 2h，延迟组为 240h。在随访期间，早期侵入组的主要终点显著降低[风险比（HR），0.52；95%置信区间（CI），0.30-0.87；p=0.01]。在调整混杂因素后，早期侵入组的主要终点发生率显著低于延迟侵入组（HR，0.44；95% CI，0.23-0.78；p=0.004）。
在 NSTE-ACS 合并 CHF 患者的长期随访中，早期侵入性策略与较低的复合主要终点风险相关。
