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非ST段抬高急性冠状动脉综合征介入治疗的5年结果:英国心脏基金会rita3随机试验

世界核心医学期刊文摘(心脏病学分册) 2006年第2期 22-23页

作者： Fox K. A. A. Poole-Wilson P. Clayton T. C. 孙凯 Centre for Cardiovascular Science Department of Medical and Radiological Sciences University of Edinburgh Edinburgh EH16 4SB United Kingdom Prof.

Background: The long-term outcome of an interventional strategy in patients with non-ST-elevation acute coronary syndrome is unknown. We tested whether an interventional strategy(routine angiography followed by revascularisation) was better than a conservative strategy(ischaemia-driven or symptom-driven angiography) over 5 years' follow-up. Methods: In a multicentre randomised trial, 1810 patients(from 45 hospitals in England and Scotland, UK) with non-ST-elevation acute coronary syndrome were randomly assigned to receive an early intervention(n=895) or a conservative strategy(n=915)within 48 h of the index episode of cardiac pain. In each group, the aim was to provide the best medical treatment, and also to undertake coronary arteriography within 72 h in the interventional strategy with subsequent management guided by the angiographic findings. Analysis was by intention to treat and the primary outcome(composite of death or non-fatal myocardial infarction) had masked independent adjudication. rita 3 has been assigned the International Standard Randomised Control Trial Number ISRCTN07752711. Findings: At 1-year follow-up, rates of death or non-fatal myocardial infarction were similar. However, at a median of 5 years' follow-up(IQR 4.6-5.0), 142(16.6% ) patients with intervention treatment and 178(20.0% ) with conservative treatment died or had non-fatal myocardial infarction(odds ratio 0.78, 95% CI 0.61-0.99, p=0.044), with a similar benefit for cardiovascular death or myocardial infarction(0.74, 0.56-0.97, p=0.030). 234(102 12% intervention, 132 15% conservative) patients died during follow-up(0.76, 0.58-1.00, p=0.054). The benefits of an intervention strategy were mainly seen in patients at high risk of death or myocardial infarction(p=0.004), and for the highest risk group, the odds ratio of death or non-fatal myocardial infarction was 0.44(0.25-0.76). Interpretation: In patients with non-ST elevation acute coronary syndrome, a routine invasive strategy leads to

关键词：急性冠状动脉综合征患者 rita3 介入治疗 ST 随机试验概率试验

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