摘要
目的:对于非ST段抬高型心肌梗死(NSTEMI)经皮冠状动脉介入治疗(PCI)后合理住院观察时间一直富有争议,很少有研究探讨术后早期出院对NSTEMI患者早期预后的影响。本文试图通过观察NSTEMI患者PCI后早期出院对早期预后的影响,以期探讨NSTEMI患者PCI术后早期出院的安全及可行性。方法:回顾性收集1424例NSTEMI患者成功PCI后的基线临床特征、病变特征及PCI治疗过程,根据出院时间,将其分为早期出院组(432例,<24h)及常规出院组(992例,2~3d)。为平衡两组基线特征差异,采用倾向性评分配对处理。主要的观察终点为不良心脑血管事件和出血及入路血管相关并发症的复合终点事件发生率。结果:分析出院后30d内不良事件发生率发现,早期出院组不良临床事件发生率为8.6%(37/432),低于常规出院组的11.6%(115/992),但差异无统计学意义(P=0.09)。主要原因是相对于早期出院组,常规出院组更少选择经桡动脉入路(827/932,83.4%vs.387/432,89.5%,P=0.00)所致。经倾向评分校正后,两组不良事件发生率差异消失。结论:对于接受成功PCI治疗的NSTEMI患者,经过精心筛选和评估,早期出院(<24h)是安全可行的。
Objective:The rational length of stay following non-complicated percutaneous coronary intervention(PCI)for non-ST elevation myocardial infarction(NSTEMI)patients remains controversial.Few studies have examined the impact of early discharge on short-term outcomes in NSTEMI patients.In order to evaluate the safety and feasibility of short time discharge following non-complicated PCI for NSTEMI patients,the 30-day net adverse clinical events in NSTEMI patients were compared between short time discharge group and routine time discharge group.Methods:This retrospective study enrolled 1424 consecutive patients with NSTEMI diagnoses who underwent non-complicated PCI.Of these patients,432 were discharged early(<24 hours),whereas the remaining 992 NSTEMI patients underwent routine discharge.The primary end points of the study were the net adverse clinical events including major adverse cardiac or cerebral events or access site vascular/bleeding complications within 30 days.The differences between the two groups were analyzed after propensity score matching to reduce selection bias.Results:The incidence of crude 30-day net adverse events was numerically higher in the long-time discharge group at 11.6%(115/992)compared with 8.6%(37/432)in the short-time discharge group,although this difference was not significant(P=0.09).This difference was mainly due to lesser radial access selected in the long-time discharge group(827/932,83.4%vs.387/432,89.5%,P=0.00).After PS matching to balance the access difference,there was no significant difference in the incidence of the events mentioned above between two groups.Conclusions:If an NSTEMI patient undergoes PCI without any procedural complications,short-time discharge after successful PCI would be feasible and safe.
作者
汪国忠
赵全明
陈青
张晓霞
田磊
吴小凡
WANG Guozhong;ZHAO Quanming;CHEN Qing;ZHANG Xiaoxia;TIAN Lei;WU Xiaofan(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2019年第5期447-451,共5页
Journal of Cardiovascular and Pulmonary Diseases
