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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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