Comparison of outcome of patients with unstable angina and non-Q-wave acute myocardial infarction with and without prior coronary artery bypass grafting (Thrombolysis in Myocardial Ischemia III Registry).
Comparison of outcome of patients with unstable angina and non-Q-wave acute myocardial infarction with and without prior coronary artery bypass grafting (Thrombolysis in Myocardial Ischemia III Registry).
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不稳定型心绞痛和非 Q 波急性心肌梗死患者接受和未接受冠状动脉旁路移植术的结果比较（心肌缺血 III 登记处的溶栓）。
DOI：
10.1016/s0002-9149(97)89383-6
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Stone,PH
中科院分区：
文献类型：
--
作者：
Kleiman,NS;Anderson,HV;Rogers,WJ;Theroux,P;Thompson,B;Stone,PH
本研究的目的是在前瞻性确定的不稳定心绞痛或非 Q 波心肌梗死患者队列中，对既往接受过或未接受过冠状动脉旁路移植术 (CABG) 的患者进行特征分析。心肌梗死溶栓治疗 III 期登记前瞻性研究中的患者在发作或不稳定心绞痛或非 Q 波急性心肌梗死后 96 小时内就诊。在 2,048 名患者中，336 名 (16.4%) 既往接受过 CABG。与既往未接受过 CABG 的患者相比，患者年龄相同，但更有可能是男性、白人、糖尿病患者、有心绞痛或心肌梗死病史、在前一周接受过抗缺血药物治疗、在住院期间接受静脉注射肝素或硝酸甘油或两者兼而有之。他们接受冠状动脉血管成形术或冠状动脉搭桥术的可能性相同。接受过 CABG 的患者和未接受过 CABG 的患者在第 10 天发生死亡或非致命性心肌梗塞的比例分别为 4.5% 和 2.8% (p = 0.11)；到第 42 天分别为 7.7% 和 5.1% (p = 0.03)。既往接受过 CABG 的患者中，1 年时死亡、心肌梗死或复发性缺血的复合情况更为常见（39.3% vs 30.2%，p = 0.002）。通过多重 Logistic 回归，既往 CABG 与 6 周或 1 年时死亡或心肌梗死或死亡、心肌梗死或复发性缺血的复合事件的发生并不独立相关。与既往未接受过 CABG 的患者相比，接受过 CABG 的患者复发缺血事件的可能性更大，但最有可能的解释是基线或治疗特征的差异，这些差异反映了潜在心脏病的程度。
The aim of this study was to characterize patients with and without prior coronary artery bypass grafting (CABG) among a prospectively identified cohort of patients presenting with unstable angina or non-Q-wave myocardial infarction. Patients in the Thrombolysis in Myocardial Infarction phase III Registry Prospective Study presented within 96 hours of an episode or unstable angina or non-Q-wave acute myocardial infarction. Of 2,048 patients, 336 (16.4%) had prior CABG. Compared with those without prior CABG, patients were the same age, but were more likely to be men, white, diabetic, have a history of angina or myocardial infarction, to have received anti-ischemic medications in the prior week, and to receive intravenous heparin or nitroglycerin, or both, during hospitalization. They were equally likely to undergo coronary angioplasty or CABG. Death or nonfatal myocardial infarction occurred by day 10 in 4.5% of patients with prior CABG and 2.8% of patients without prior CABG (p = 0.11); and by day 42 in 7.7% and 5.1%, respectively (p = 0.03). The composite of death, myocardial infarction, or recurrent ischemia at 1 year was more common among patients with prior CABG (39.3% vs 30.2%, p = 0.002). By multiple logistic regression, prior CABG was not independently associated with the occurrence of death or myocardial infarction, or the composite of death, myocardial infarction, or recurrent ischemia either at 6 weeks or at 1 year. The likelihood of recurrent ischemic events is greater among patients with than without prior CABG, but is most likely explained by differences in baseline or treatment characteristics which reflect the degree of underlying cardiac disease.