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目的探讨早期有创干预对高危无ST段抬高急性冠状动脉综合征(ACS)患者的近远期预后影响。方法2001年10月至2003年10月期间连续入院的无ST段抬高ACS患者545例,随机分成早期保守治疗组(284例)与早期有创干预组(261例),随访患者30d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),评价早期有创干预对肌钙蛋白(Tn)Ⅰ或高敏感C反应蛋白(hs-CRP)水平增高的高危患者近、远期预后的影响。结果与早期保守治疗组比较,早期有创干预降低随访30d时的反复心绞痛发作住院事件及随访30d与6个月时的复合心血管事件(P值均<0·05);亚组分析示早期有创干预可明显降低TnI增高或hs-CRP增高患者30d及6个月的复合心血管事件及6个月硬性终点事件发生率(均P值<0·01),对TnI或hs-CRP水平正常者,早期有创干预无明显优势。结论早期有创干预能明显降低TnI或hs-CRP水平增高的高危患者的心血管事件,改善患者的近、远期预后。
Objective To explore the short-term and long-term prognosis of early invasive intervention in patients with high-risk ST-segment elevation acute coronary syndrome (ACS). Methods 545 consecutive ST-segment elevation ACS patients admitted from October 2001 to October 2003 were randomly divided into early conservative treatment group (n = 284) and early invasive treatment group (n = 261). Patients were followed up for 30 and 6 Months of composite cardiovascular events (including cardiac death, non-fatal myocardial infarction, nonfatal heart failure, hospitalizations for recurrent ischemic angina pectoris), evaluation of early invasive intervention on troponin (Tn) I or high The effect of short-term and long-term prognosis of high-risk patients with elevated levels of hs-CRP. Results Compared with the early conservative treatment group, early invasive intervention decreased the incidence of recurrent angina pectoris at 30 days of follow-up and composite cardiovascular events at 30 days and 6 months follow-up (all P <0.05). Subgroup analysis showed that early stage Intrusive intervention could significantly reduce the incidence of composite cardiovascular events and 6-month rigid end point events (both P <0.01) in patients with elevated TnI or increased hs-CRP at 30 and 6 months, and significantly decreased the levels of TnI or hs-CRP Normal, early invasive intervention no obvious advantage. Conclusion Early invasive intervention can significantly reduce cardiovascular events in high-risk patients with elevated TnI or hs-CRP, and improve the short-term and long-term prognosis of patients.