Unanswered questions for management of acute coronary syndrome - Risk stratification of patients with minimal disease or normal findings on coronary angiography
Unanswered questions for management of acute coronary syndrome - Risk stratification of patients with minimal disease or normal findings on coronary angiography
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DOI：
10.1001/archinte.166.13.1391
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发表时间：
2006-07-10
影响因子：
--
通讯作者：
De Ferrari, Gaetano M.
中科院分区：
文献类型：
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作者：
Bugiardini, Raffaele;Manfrini, Olivia;De Ferrari, Gaetano M.
背景：血管造影发现正常或接近正常的胸痛对预后的影响尚不清楚。我们探讨了非ST段抬高急性冠脉综合征的非梗阻性冠状动脉疾病患者的危险分层的结果和方法。方法：收集了3个心肌梗死溶栓试验(TIMI 11B、TIMI 16和TIMI 22)的数据。对7656例非ST段抬高急性冠脉综合征患者的血管造影资料进行了分析。这项分析的主要终点是1年随访时死亡率、心肌梗死、需要再住院的不稳定心绞痛、血运重建和中风的比率的综合。结果：冠状动脉造影结果显示，7656例患者中710例(9.1%)为非梗阻性冠状动脉病变，其中48.7%为正常冠状动脉(0%狭窄)，51.3%为轻度冠状动脉病变(0%~50%狭窄)。101名患者(12.1%)发生了主要终点事件。值得注意的是，这些患者在1年的随访中发生了2%的死亡和心肌梗死事件。随着TIMI危险评分从0.6%(1分)增加到4.0%(4分以上)，死亡和心肌梗死事件发生率显著增加。结论：冠状动脉造影术发现非ST段抬高急性冠脉综合征合并非梗阻性冠状动脉疾病患者在1年内发生再发冠状动脉事件的风险较大。风险并不是单变量高的，TIMI风险评分有助于揭示高风险患者。
Background: The prognostic implication of chest pain associated with normal or near-normal findings on angiography is still unknown. We explored outcomes and methods of risk stratification in patients with nonobstructive coronary artery disease in the setting of non ST-segment elevation acute coronary syndromes.Methods: Data were pooled from 3 Thrombolysis in Myocardial Infarction (TIMI) trials (TIMI 11B, TIMI 16, and TIMI 22). Angiographic data were available on 7656 patients with non-ST-segment elevation acute coronary syndromes. The primary end point of this analysis was the composite of the rates of death, myocardial infarction, unstable angina requiring rehospitalization, revascularization, and stroke at 1-year follow-up. Outcomes were evaluated by mean of the TIMI risk score for developing at least 1 component of the primary end point.Results: Angiographic findings showed that 710 (9.1%) of 7656 patients had nonobstructive coronary artery disease; 48.7% of these had normal coronary arteries (0% stenosis), and 51.3% had mild coronary artery disease (> 0% to < 50% stenosis). A primary end-point event occurred in 101 patients (12.1%). It is noteworthy that a 2% event rate of deaths and myocardial infarctions had occurred in these patients at the 1-year follow-up. Event rates of death and myocardial infarction increased significantly as the TIMI risk score increased from 0.6% for a score of 1 to 4.0% for a score greater than 4.Conclusions: Patients with non-ST-segment elevation acute coronary syndromes with nonobstructive coronary artery disease detected by angiography have a substantial risk of subsequent coronary events within 1 year. The risk is not univariately high, and the TIMI risk score helps to reveal patients at high risk.