不同时期中国非ST段抬高型急性冠状动脉综合征患者临床特征与预后
불동시기중국비ST단태고형급성관상동맥종합정환자림상특정여예후
Clinical characteristics and prognosis comparison of Chinese non ST-segment elevation acute coronary syndrome patients in two different time periods
  • 万方数据
    中华心血管病杂志 중화심혈관병잡지
    Chinese Journal of Cardiology
    2014年 8期 655-660 ,共6页

    白莹%梁岩%谭慧琼%乔树宾%张峻%杨艳敏%章晏%朱俊

    백형%량암%담혜경%교수빈%장준%양염민%장안%주준

    冠状动脉疾病%血管成形术,经腔,经皮冠状动脉%药物疗法%治疗结果 冠狀動脈疾病%血管成形術,經腔,經皮冠狀動脈%藥物療法%治療結果
    관상동맥질병%혈관성형술,경강,경피관상동맥%약물요법%치료결과
    Coronary disease%Angioplasty,transluminal,percutaneous coronary%Drug therapy%Treatment outcome
    目的 比较分析不同时期中国非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者的临床特征、治疗方式及预后,了解时代变化对患者人群特点和治疗效果的影响.方法 两组病例来自不同时期的两个国际大规模NSTE-ACS临床试验中所有接受冠状动脉造影的中国患者.共入选1 473例NSTE-ACS患者,其中749例来自1999年4月至2000年12月我国38个中心开展的组织评估缺血综合征策略登记(OASIS)研究(OASIS组);另724例者来自2007年4月至2008年6月我国24个中心参与的对比NSTE-ACS治疗的国际随机研究(TIMACS组).随访时间均为患者入选之日起的180 d.比较其临床特征、治疗方式及预后.结果 与OASIS组比较,TIMACS组的患者年龄较大[(64.2±10.1)岁比(58.7±10.2)岁],男性比例较少[66.3％(480/724)比74.4％(557/749)],入院时血压较低,有较多的既往介入治疗史[9.4％(68/724)比6.4％(48/749)]、卒中史]8.8％ (64/724)比5.1％(38/749)]、高血压史[62.8％ (455/724)比56.6％(424/749)]和糖尿病史[23.3％(169/724)比16.2％(121/749)]的患者,而冠心病史]37.4％(271/724)比59.1％(443/749)]和心肌梗死史[12.0％(87/724)比27.6％ (207/749)]的患者所占比例较低(P均＜0.05).住院期间TIMACS组PCI治疗比例较高[74.9％(524/724)比49.3％(369/749),P＜0.001].住院期间,出院带药和180 d随访时TIMACS研究在冠心病二级预防药物[β受体阻滞剂、血管紧张素转换酶抑制剂和(或)血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)、调脂药等]应用比例及患者的依从性明显高于OASIS组(P均＜0.05).180 d随访时TIMACS组联合终点事件发生率明显低于OASIS组[13.3％(96/724)比25.2％(189/749),P＜0.001],特别是顽固性心绞痛[5.2％(38/724)比22.6％(169/749),P＜0.001]明显减少.应用Cox回归模型对基线水平和住院期间相关治疗进行校正后,TIMACS组发生联合终点事件(HR =0.39,95％CI:0.29～0.53,P＜0.001)和顽固性心绞痛或心绞痛再入院事件(HR =0.17,95％CI:0.11 ～0.25,P＜0.001)的风险降低.结论 TIMACS研究的患者在PCI治疗、冠心病二级预防等方面优于OASIS研究,180 d随访的联合终点事件发生明显少于后者.提示随着国内外指南的更新和临床诊治水平的提高,中国在NSTE-ACS治疗方面有明显的进步.
    목적 비교분석불동시기중국비ST단태고형급성관상동맥종합정(NSTE-ACS)환자적림상특정、치료방식급예후,료해시대변화대환자인군특점화치료효과적영향.방법 량조병례래자불동시기적량개국제대규모NSTE-ACS림상시험중소유접수관상동맥조영적중국환자.공입선1 473례NSTE-ACS환자,기중749례래자1999년4월지2000년12월아국38개중심개전적조직평고결혈종합정책략등기(OASIS)연구(OASIS조);령724례자래자2007년4월지2008년6월아국24개중심삼여적대비NSTE-ACS치료적국제수궤연구(TIMACS조).수방시간균위환자입선지일기적180 d.비교기림상특정、치료방식급예후.결과 여OASIS조비교,TIMACS조적환자년령교대[(64.2±10.1)세비(58.7±10.2)세],남성비례교소[66.3％(480/724)비74.4％(557/749)],입원시혈압교저,유교다적기왕개입치료사[9.4％(68/724)비6.4％(48/749)]、졸중사]8.8％ (64/724)비5.1％(38/749)]、고혈압사[62.8％ (455/724)비56.6％(424/749)]화당뇨병사[23.3％(169/724)비16.2％(121/749)]적환자,이관심병사]37.4％(271/724)비59.1％(443/749)]화심기경사사[12.0％(87/724)비27.6％ (207/749)]적환자소점비례교저(P균＜0.05).주원기간TIMACS조PCI치료비례교고[74.9％(524/724)비49.3％(369/749),P＜0.001].주원기간,출원대약화180 d수방시TIMACS연구재관심병이급예방약물[β수체조체제、혈관긴장소전환매억제제화(혹)혈관긴장소Ⅱ수체길항제(ACEI/ARB)、조지약등]응용비례급환자적의종성명현고우OASIS조(P균＜0.05).180 d수방시TIMACS조연합종점사건발생솔명현저우OASIS조[13.3％(96/724)비25.2％(189/749),P＜0.001],특별시완고성심교통[5.2％(38/724)비22.6％(169/749),P＜0.001]명현감소.응용Cox회귀모형대기선수평화주원기간상관치료진행교정후,TIMACS조발생연합종점사건(HR =0.39,95％CI:0.29～0.53,P＜0.001)화완고성심교통혹심교통재입원사건(HR =0.17,95％CI:0.11 ～0.25,P＜0.001)적풍험강저.결론 TIMACS연구적환자재PCI치료、관심병이급예방등방면우우OASIS연구,180 d수방적연합종점사건발생명현소우후자.제시수착국내외지남적경신화림상진치수평적제고,중국재NSTE-ACS치료방면유명현적진보.
    Objective To compare the clinical characteristics,treatment methods and outcomes in Chinese non ST-segment elevation acute coronary syndrome (NSTE-ACS) patients from two large clinical trials in different time periods.Methods All Chinese NSTE-ACS patients from two large International clinical trials (OASIS Registry and TIMACS) underwent coronary artery angiography after first admission were recruited in our analysis.The follow-up time was 180 days.A total of 1 473 NSTE-ACS patients were recruited in this analysis,in which 749 from Organization to Assess Strategies for Ischemic Syndromes (OASIS REISTRY) that completed in 38 centers in China from April 1999 to December 2000,and the rest 724 patients from The Timing of Intervention in Acute Coronary Syndromes (TIMACS) trial in 24 centers in China performed from April 2007 to June 2008.Results Compared to OASIS patients,TIMACS group were older ((64.2 ± 10.1) years old vs.(58.7 ± 10.2) years old),and fewer male patients (66.3％ (480/724) vs.74.4％ (557/749)),lower blood pressure at admission,and more histories of previous PCI (9.4％ (68/724 vs.6.4％ (48/749)),stroke (8.8％ (64/724) vs.5.1％ (38/749)),hypertension (62.8％ (455/724) vs.56.6％ (424/749)) and diabetes (23.3％ (169/724) vs.16.2％ (121/749)),lower histories of coronary artery disease (37.4％ (271/724) vs.59.1％ (443/749)) and myocardial infarction (12.0％ (87/724) vs.27.6％ (207/749)) (all P ＜ 0.05).After admission,comparing to OASIS group,TIMACS patients had significant higher PCI proportion (74.9％ (524/724) vs.49.3％ (369/749),P ＜ 0.001).In addition,for secondary prevention,TIMACS patients had significant higher standard medication treatment proportion during hospitalization,at discharge and at 180 days follow up than OASIS group (P ＜ 0.05 for β-blocker,ACEI/ARB and lipid lowering drugs) and higher compliance rate.The combined primary outcome event rate at 180 days was much lower in TIMACS than in OASIS patients (13.3％ (96/724) vs.25.2％ (189/749),P ＜0.001) mostly due to the reduction on the refractory angina (5.2％ (38/724) vs.22.6％ (169/749),P ＜ 0.001).Results of COX regression model adjusted for baseline levels and treatment during hospitalization showed that the incidence rate of combination endpoint (HR =0.39,95％ CI:0.29-0.53,P ＜ 0.001) and refractory ischemia/angina rehospitalization (HR =0.17,95％ CI:0.11-0.25,P ＜ 0.001) were both lower in TIMACS patients than in OASIS patients.Conclusion PCI procedure and secondary prevention medication administration are more often applied in TIMACS patients than in OASIS group,which is related to less integrated incidence of primary outcomes reflecting progress in Chinese medical care for non ST elevated acute coronary syndrome patients according to the updated guidelines.
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