不稳定型心绞痛经皮冠状动脉介入治疗与内科保守治疗的比较  

Comparison of percutaneous coronary intervention versus conservative treatment in unstable angina pectoris

作　　者：胡春燕[1] 吕蓓[2] 沈卫峰[2] 陆国平[2] 

机构地区：[1]上海市南汇区中心医院心内科,201300 [2]上海第二医科大学附属瑞金医院心内科

出　　处：《介入放射学杂志》2002年第5期332-335,共4页Journal of Interventional Radiology

摘　　要：目的　探讨经皮冠状动脉 (冠脉 )介入 (PCI)治疗与内科保守治疗对不稳定型心绞痛(UAP)患者的疗效。方法　 2 4 8例UAP患者 ,其中保守组 12 3例 ,接受阿司匹林、肝素和抗心绞痛药物治疗 ;介入治疗组 12 5例 ,除上述药物治疗外 ,于入院后平均 4 .4d行PCI治疗 ,随访两组首次入院后 1年内终点事件 :死亡、急性心肌梗死 (AMI)、心绞痛复发和再入院等。结果　介入组与保守组住院期死亡或AMI复合终点发生率无显著差异 (分别为 0 .8%和 1.6 % ,P >0 .0 5 ) ,但介入组住院天数缩短 ,分别为 (10 .3± 5 .6 )d和 (14 .6± 10 .7)d ,(P <0 .0 .0 1) ;介入组较保守组 1年的AMI发生率 (分别为 2 .4 %和8.9% ,P <0 .0 3)、病死率 (分别为 1.6 %和 6 .5 % ,P <0 .0 5 )、死亡或AMI复合终点发生率 (分别为 4 .0 %和 13.0 % ,P <0 .0 2 )、心绞痛复发率 (分别为 2 6 .4 %和 4 8.7% ,P <0 .0 0 1)、CABG率 (分别为 1.6 %和 10 .5 % ,P <0 .0 1)、再入院率 (分别为 2 4 .8%和 4 5 .5 % ,P <0 .0 1)均显著降低。 1年无发生死亡或AMI复合终点的生存率 :介入组显著高于保守组 (分别为 96 .0 %和 86 .9% ,P <0 .0 2 )。亚组分析显示 ,PCI降低UAP患者死亡或AMI复合终点发生率的人群主要是高危患者 ,如静息型心绞痛、TNT阳性、3支?Objective To evaluate the efficacies of percutaneous coronary intervention (PCI) and drug treatment in patients with unstable angina (UAP). Methods 248 patients with UAP were divided into two groups: conservative group of 123 patients who received antiplatelet, anticoagulant and antianginal therapies only and invasive group of 125 patients who underwent additional PCI 4.4 days after admission, The ocurrence of death, AMI, recurrent angina, readmission were assessed during the first hospitilization year. Results There was no difference in the incidence of composite endpoint of death or AMI between the two groups during the hospitalization (0.8% vs 1.6%, P >0.05), but hospitalization duration was shorter in the invasive group than in the conservative group (10.3±5.6 days vs 14.6±10.7 days, P <0.01). In duration of one year, the incidence of AMI (2.4% vs 8.9%, P <0.03),death (1.6% vs 6.5%, P <0.05), composite endpoint of death or AMI (4.0% vs 13.0% P =0.02), recurrent angina pectoris (26.4% vs 48.7 P <0.001), CABG(1.6% vs 10.5%, P <0.01) and readmission (24.8% vs 45.5%, P <0.01) were also lower in the invasive group than in the conservative group. Survival rate free of composite death or AMI for 1 year was higher in the invasive group than in the conservative group(96.0% vs 86.9%, P <0.02). There was a definite benefit of the invasive treatment in reducing the risk of composite endpoint of death or AMI in patients with chest pain at rest, troponin T positive and three vessel diseases. Old age, three vessel diseases, LAD disease, lower LVEF, ST segment depression, diabetes and hypertension were the independent factors associated with composite of death or AMI. Conclusions In patients with UAP, PCI associated with routine antiplatelet, anticoagulant and antiischemic treatment significantly decreases the incidence of adverse cardiac events and improves the survival rate in one year. Such beneficial effects can be more obvious for high risk patients.

关 键 词：血管成形术 疗效分析 不稳定型心绞痛 经皮冠状动脉介入治疗 内科保守治疗 

分 类 号：R541.4[医药卫生—心血管疾病] R815[医药卫生—内科学]