经皮冠状动脉介入治疗不稳定型心绞痛和非ST段抬高心肌梗死的临床研究.docVIP

经皮冠状动脉介入治疗不稳定型心绞痛和非ST段抬高心肌梗死的临床研究 　　作者：黄树温 李克清 王 磊 牟瑞起 王荣彬 张 雁 　　【摘要】 目的 比较不稳定型心绞痛和非ST段抬高心肌梗死患者应用经皮冠状动脉介入治疗和药物治疗的疗效。方法 选择我院心内科病房住院的不稳定型心绞痛和非ST段抬高心肌梗死患者共536例，分为药物保守治疗组和经皮冠状动脉介入治疗组。介入治疗组在药物治疗基础上于入院1～10 d行冠状动脉造影，据结果施行介入治疗术。随访患者1～24个月的心绞痛复发率、再次入院率和再次介入治疗率或血管搭桥术(次要终点)，以及心源性死亡和(或)急性心肌梗死发生率(主要终点)。结果 260例病人施行介入治疗，276例病人接受药物治疗。在1~24(1，6，12，24)个月随访中，介入治疗组的心源性死亡和(或)急性心肌梗死发生率明显低于药物治疗组(分别为12%∶47%，12%∶58%，19%∶54%，15%∶69%，P均0.01);心绞痛复发率介入治疗组明显低于药物治疗组(61%∶203%,10%∶355%，119%∶406%,135%∶446%,P均0.001);再入院率介入治疗组明显低于药物治疗组(5%∶185%,81%∶326%,104%∶373%,10%∶421%,P均0.001);再次接受介入治疗或血管搭桥术的病人在介入治疗组亦明显低于药物治疗组(15%∶58%,23%∶80%,31%∶65%,35%∶83%,P均001)。结论 经皮冠状动脉介入治疗能显著改善不稳定型心绞痛和非ST段抬高心肌梗死患者的预后，优于传统的药物治疗，可作为大多数患者的首选治疗方法。 　　【关键词】 经皮冠状动脉血管成形术;心绞痛;非ST段;心肌梗死 　　【中图分类号】 R541.4 　　Percutaneous coronary intervention for treatment of unstable angina or nonSTsegment elevation myocardial infarction 　　HUANG Shuwen LI Keqing WANG Lei et al 　　Department of Cardiology,Peoples Hospital of Dezhou,Dezhou 253014 　　【Abstract】 Objective To compare the efficacy of percutaneous coronary intervention(PCI) with that of drug therapy in patients with unstable angina or nonSTsegment elevation myocardial infarction.Methods 536 patients with unstable angina or nonSTSegment elevation myocardial infarction were divided into two groups (conservative vs PCI)according to management strategy.In PCI group, coronary angiography and PCI were performed 1-10 days after admission.Patients were followed up for 1―24 months. Cardiac death and acute myocardial infarction were the primary endpoint. Recurrence angina,readmisson and revascularization were the secondary endpoint.Results There were 260 patients in PCI group and 276 patients in conservative group.During followup(1,6,12,24 months),there was a decrease in the primary endpoint in the PCI group compared with that in conservative group (12%vs 47%,12%vs 58%,19%vs 54%,15%vs 69%,P0.01).The rates of recurrent angina(6.1%vs 203%, 1%vs 355%,119%vs 406%,135%vs 446%,P0.001