非ST段抬高急性冠状动脉综合征心电图变化及早期有创干预  

The changes of electrocardiogram and impact of early invasive strategy in patients with acute coronary syndromes without ST-segment elevation

作　　者：赵明中[1] 胡大一[1] 张福春[2] 吴炀[3] 晏沐阳[4] 王士雯[4] 毛节明[2] 杨明[5] 姜立清[3] 

机构地区：[1]北京大学人民医院心内科,100044 [2]北京大学第三医院 [3]首都医科大学附属北京同仁医院 [4]解放军总医院 [5]首都医科大学附属北京复兴医院

出　　处：《中华医学杂志》2005年第13期879-882,共4页National Medical Journal of China

基　　金：北京市科技项目基金资助(H010210330113);卫生部属医疗机构临床学科重点项目基金资助(20011014)

摘　　要：目的探讨非ST段抬高急性冠状动脉综合征(ACS)的心电图变化及早期有创干预的价值.方法 2001年10月至2003年10月连续入院的非ST段抬高的ACS患者共545例,分成早期保守治疗组与早期有创干预组,随访患者30 d与6个月的复合心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院),评价心电图不同变化以及不同干预策略对患者预后的影响.结果随访545例患者中ST段压低者的单项心血管事件与复合事件均较其他心电图改变者明显增多,ST段压低变量是患者6个月复合心血管事件危险性增加的独立预测因素之一(OR 3.864, 95%CI: 1.668～9.451, P<0.001).与早期保守治疗组比较,早期有创干预组随访30 d时反复心绞痛发作住院事件减少,随访30 d 与6个月时复合心血管事件也减少(均P<0.05);亚组分析示ST段压低患者早期有创干预能明显降低30 d及6个月复合心血管事件(均P<0.01),无ST段压低患者并无类似获益.结论 ST段压低是预测患者能从早期有创干预中获益的有效指标;早期有创干预较早期保守治疗能明显降低ST段压低的ACS患者的心血管事件.Objective To investigate the changes of electrocardiogram (ECG) and impact of early invasive strategy in patients with acute coronary syndrome (ACS) without ST-segment elevation.MethodsFive hundred and forty-five consecutive ACS patients without ST-segment elevation were randomly assigned to early conservative treatment group and early invasive treatment group.The combined cardiovascular events, including cardiac death, nonfatal myocardial infarction, nonfatal heart failure, and re-hospitalization due to recurrent ischemia angina, within 30 days and 6 months were analyzed and the effects of varied ECG changes and different intervention strategies on outcomes of patients were evaluated.Results The incidences of each and combined cardiovascular events were higher in the patients with ST-segment depression than in those without ST-segment depression.ST-segment depression was one of independent predictive factors for an increase in cardiovascular events within 6 months(OR 3.864, 95%CI: 1.668~9.451, P<0.001).Early invasive strategy was associated with a lower rate of re-hospitalization due to recurrent ischemia angina within 30 days and a decreased incidence of combined cardiovascular events within 30 days and 6 months in comparison with the early conservative treatment group (all P<0.05).Subgroup analysis implied that incidences of combined cardiovascular events within 30 days and 6 months decreased significantly only in patients with ST-segment depression treated with early invasive strategy, and no such benefit was seen in the patients without ST-segment depression.Conclusion ST-segment depression is an effective indicator for identifying those patients with non-ST segment elevation ACS most likely to benefit from early invasive strategy.Early invasive strategy markedly decreases the cardiovascular events in ACS patients with ST-segment depression than early conservative strategy.

关 键 词：非ST段抬高急性冠状动脉综合征 有创干预 心电图变化 心血管事件 ST段压低 心绞痛发作 独立预测因素 早期保守治疗 2003年 2001年 心脏性死亡 性心肌梗死 心电图改变 心力衰竭 非致命性 干预策略 有效指标 ACS 治疗组 患者 

分 类 号：R541.4[医药卫生—心血管疾病]