在高风险的没有血液动力学不稳定的NSTEMI患者中,非常早期与延迟的侵入性策略:来自KAMIR-NIH的洞察力
Seung Do Lee1, Rock Bum Kim2, Chang-Ok Seo1
1Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
PloS one
|June 6, 2024
概括
对于没有不稳定的高风险非ST升高心肌梗塞 (NSTEMI) 患者,非常早期的入侵策略 (VEIS) 显示出比延迟的入侵策略 (DIS) 更糟糕的结果. 这表明DIS对于这些特定的NSTEMI患者可能更安全.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床研究 临床研究
背景情况:
- 在高风险的非ST升高心肌梗塞 (NSTEMI) 中,穿皮冠状动脉干预 (PCI) 的最佳时间仍在争论中.
- 建议早期进行再血管,但非常早期入侵策略 (VEIS) 与延迟入侵策略 (DIS) 的好处需要在特定的患者亚组中进一步调查.
研究的目的:
- 为了比较没有血液动力学不稳定的NSTEMI患者接受VEIS (≤12小时) 与DIS (>12小时) 的临床结果.
- 评估风险分层对NSTEMI中不同侵入性策略的结果的影响.
主要方法:
- 总共有4733名来自韩国急性心肌梗塞登记-国家卫生研究院 (KAMIR-NIH) 的NSTEMI患者被分析.
- 根据全球急性冠状动脉事件注册表 (GRACE) 风险评分 (GRS) 将患者分为低风险和高风险组.
- 包括所有原因死亡,心脏病死亡,复发性心脏病发作和12个月后脑血管事故在内的结果被评估为VEIS和DIS组.
主要成果:
- 在低GRS组中,VEIS和DIS在12个月后显示了类似的结果.
- 在高GRS组中,VEIS与DIS (HR=1.46,P=0.003) 相比,与明显更糟糕的全因死亡结果有关.
- 倾向性得分匹配证实了VEIS在高风险患者中的不良影响 (HR=1.34,P=0.042).
结论:
- 非常早期的侵入性策略 (VEIS) 与高风险的无血液动力学不稳定性NSTEMI患者的延迟侵入性策略 (DIS) 相比,与更糟糕的临床结果有关.
- 这些发现表明,在现实实践中,对于选择高风险的NSTEMI患者来说,延迟的侵入性治疗方法可能是更好.
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