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目的评价非ST段抬高急性冠状动脉综合征(acute coronary syndrome,ACS)患者早期应用紧急经皮冠状动脉介入治疗(PCI)的临床疗效。方法2000年1月至2005年9月我院收治的385例中、高危非ST段抬高ACS患者,根据药物治疗后病情变化,分别在入院1~2 d内(233例,紧急介入组)或3~14 d(152例,延迟介入组)行冠状动脉造影(CAG)及PCI。所有“罪犯”病变均予治疗,介入方法有经皮冠状动脉腔内成形术(PTCA)+支架、直接置入支架等。观察两组手术成功率、心绞痛缓解时间、住院时间和PCI后30 d及6个月心源性死亡、心绞痛复发等不良心脏事件发生率。结果紧急介入组手术成功率与延迟介入组相似,分别为98.1%和95.5%(P>0.05),但入院至心绞痛缓解时间分别为(2.9±1.1)d和(6.0±3.6)d(P<0.05);住院时间分别为(9.7±4.3)d和(14.2±6.6)d(P<0.05);在住院期间,两组患者均无急性心肌梗死、猝死及心功能恶化发生。30 d随访期间紧急介入组总不良心脏事件发生率较延迟介入组明显减少,二者分别为2.9%和14.1%(P<0.01)。结论在条件具备的介入中心,由经验丰富和技术娴熟的介入治疗医生施行或在其指导下,对非ST段抬高ACS患者进行早期紧急介入治疗是积极、有效的治疗措施,近、远期临床效果较满意,手术成功率及安全性较高,可作为大多数非ST段抬高ACS患者的首选治疗策略。
Objective To evaluate the clinical efficacy of emergency percutaneous coronary intervention (PCI) in patients with non-ST-elevation acute coronary syndrome (ACS). Methods From January 2000 to September 2005, 385 patients with high-risk and non-ST-segment elevation ACS admitted to our hospital were divided into two groups: 1 to 2 days after admission (233 cases, emergency intervention group) Or 3 ~ 14 days (152 cases, delayed intervention group) underwent coronary angiography (CAG) and PCI. All “criminal” lesions are treated, interventional methods include percutaneous transluminal coronary angioplasty (PTCA) + stent, directly into the stent. The incidences of adverse cardiac events such as cardiac success rate, angina pectoris time, hospital stay, and cardiac death and angina recurrence at 30 days and 6 months after PCI were observed. Results The success rate of operation in emergency intervention group was similar to that in delayed intervention group (98.1% vs 95.5%, P> 0.05), but the time from admission to angina pectoris was (2.9 ± 1.1) days and (6.0 ± 3.6) days, respectively 0.05). The hospital stay was (9.7 ± 4.3) d and (14.2 ± 6.6) d respectively (P <0.05). During the hospital stay, there was no acute myocardial infarction, sudden death and worsening of cardiac function in both groups. The incidence of total adverse cardiac events in the emergency intervention group during the 30-day follow-up was significantly lower than that in the delayed intervention group (2.9% and 14.1%, respectively; P <0.01). CONCLUSIONS: Early interventional procedures for non-ST-segment elevation ACS in patients with non-ST-segment elevation ACS are positive and effective treatments under the conditions of interventional centers or under the guidance of experienced and highly skilled interventional therapists The clinical results are satisfactory, the success rate and safety of surgery, can be used as the treatment of most non-ST-elevation ACS patients preferred treatment strategy.