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Long-term Prognosis of Patients with Acute non-st-segment elevation myocardial infarction undergoing Different Treatment strategies

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Chinese Medical Journal 2015年第8期128卷 1026-1031页

作者： Bo Zhang Da-Peng Shen Xu-Chen Zhou Jun Liu Rong-Chong Huang Yan-E Wang Ai-Ming Chen Ye-Ran Zhu Hao Zhu Department of Cardiology First Affiliated Hospital of Dalian Medical University Dalian Liaoning 116011 China Department of Cardiology Fuxin Center Hospital Fuxin Liaoning 123000 China Department of Cardiology Dalian Jinzhou First People's Hospital Dalian Liaoning 116100 China

Background： In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-st-segment elevation myocardial infarction （NstEMI） and characterized the patients selected for an invasive approach. Methods： A total of 976 patients with acute NstEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy （586 patients） and invasive strategy （390 patients） group. Unified tbllow-up questionnaire was performed by telephone contact （cut-off date was November, 2013）. The long-term clinical events were analyzed and related to the different treatment strategies. Results： The median follow-up time was 29 months. Mortality was 28.7% （n = 168） in the conservative group and 2.1% （n = 8） in the invasive management at long-term clinical follow-up. The secondary endpoint （the composite endpoint） was 59.0% （n = 346） in the conservative group and 30.3% （n = 118） in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management （adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]： 3.796 16.006, P 〈 0.001）, and the similar result was also seen in tile secondary endpoint （adjusted RR ： 2.102; 95% （7： 1.694-2.610, P 〈 0.001 ）. In the subgroup analysis according to each Thrombolysis in myocardial infarction risk score （TRS）, log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients （TRS 3-7）. Conclusions： An invasive strategy could improve long-term outcomes for NstEMI patients, especially for intermediate and high-risk ones （TRS 3- 7）.

关键词： lnvasive strategy Long-term Outcome non-st-segment elevation myocardial infarction Thrombolysis in Myocardia infarction Risk Score

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Relationship between serum vasoactive factors and plaque morphology in patients with non-st-segment elevated acute coronary syndrome

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Chinese Medical Journal 2010年第2期123卷 193-197页

作者： LU Ya-feng LV Shu-zheng CHEN Yun-dai Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Disease Beijing 100029 China Department of Cardiology Beijing Tongren Hospital Capital Medical University Beijing 100176 China Department of Cardiology People's Liberation Army General Hospital Beijing 100853 China

Background Vasoactive factors have been reported to correlate with vulnerable plaque and acute coronary syndrome （ACS）. This study aimed to investigate the relationship between vasoactive factors and plaque morphology in patients suffering from non-st-segment elevated ACS. Methods From April 2007 to April 2009, 124 consecutive patients suffering from non-st-segment elevated ACS who had received coronary angiography （CAG） and intravascular ultrasound （IVUS） in the People＇s Liberation Army General Hospital and Beijing Anzhen Hospital were enrolled in this study. Three serum vasoactive factors, plasma soluble vascular endothelial growth factor receptor-1 （sFIt-1）, placental growth factor （PLGF） and interleukin-18 （IL-18）, were measured by enzyme-linked-immunosorbent serologic assay of the patients. The levels of vasoactive factors were compared between vulnerable plaque group and stable plaque group, and between unstable angina pectoris （UAP） group and non-st-segment elevation acute myocardial infarction （NstE-AMI） group. The relationship between the plaque morphology and levels of vasoactive factors was analyzed. Results The levels of vasoactive factors were similar between the UAP group （69 patients） and NstE-AMI group （55 patients）. The levels of sFIt-1 and PLGF in the vulnerable plaque group were significantly higher than those in the stable plaque group. The level of IL-18 was correlated positively with plaque morphology. Multivariate Logistic regression analysis showed that the level of PLGF was an independent risk factor for vulnerable plaque （OR=2.115, 95%Cl 1.415-5.758, P=0.018）. Using the ROC curve, PLGF was a significant factor for the diagnosis of vulnerable plaque （the diagnostic point was 26.3 ng/L, the proportion of square area under the ROC curve was 0.799, 95%C/0.758-0.839, P 〈0.001 ; the sensitivity of PLGF under the ROC curve was 86%, and the specificity 63%）. Conclusion Both IL-18 and PLGF are biomarkers for vulnerable plaques and helpful to predict

关键词： non-st-segment elevation myocardial infarction unstable angina vasoactive factor vulnerable plaque: intravascular ultrasound

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