摘要
目的探讨冠状动脉CT血管造影(CTA)检查能否安全、有效地减少Grace评分为中低危的非ST段抬高型心肌梗死(NSTEMI)患者进行侵入性冠状动脉造影(ICA)的数量,提高ICA阳性率。方法前瞻性纳入2017年2月至2018年2月河南省人民医院诊治的NSTEMI患者102例,其中男61例,女41例,年龄38~80(58±12)岁。按照随机数字法分为对照组(51例)和试验组(51例)。对照组患者根据危险分层安排择期ICA检查,若需进一步介入或外科手术治疗,为ICA检查阳性;试验组患者先通过绿色通道完成CTA检查,若CTA发现冠状动脉主支及其主要分支重度及以上狭窄,安排进一步的ICA检查,否则,予以制定二级预防药物治疗方案后安排出院,随访1年。比较两组患者ICA数量、ICA阳性率、住院时间、住院花费、医院焦虑抑郁评分(HADS)、1年内主要心血管事件(MACE)及与检查或手术相关的其他严重不良事件等指标。结果试验组患者行ICA者共37例,ICA阳性率为94.59%(35/37),明显高于对照组[62.75%(32/51)](χ^2=10.28,P<0.05)。试验组平均住院时间及ICA术前HADS明显低于对照组[(3.8±2.2)d比(4.8±2.4)d、8.8±4.5比11.4±6.8](t=2.21、2.20均P<0.05)。两组间1年内MACE(3例比5例,P=0.423)及其他严重不良事件(8例比10例,P=0.548)累积发生率差异无统计学意义。结论CTA可明显减少Grace评分为中低危的NSTEMI患者的ICA数量及平均住院时间,提高ICA阳性率,且不增加1年内的心血管相关风险。
Objective To investigate whether CT coronary angiography(CTA)can safely and effectively reduce the number of invasive coronary angiography(ICA)in patients with non-ST-segment elevation myocardial infarction(NSTEMI)whose Grace score is low-or moderate-risk,and increase ICA positive rate.Methods One hundred and two NSTEMI patients,including 61 males and 41 females,aged 38-80(58±12)years,were prospectively included and treated in Henan Provincial People′s Hospital from February 2017 to February 2018.By using random number method,the patients were divided into control group(51 cases)and experimental group(51 cases).Patients in the control group were arranged for elective ICA examination according to the risk stratification.If further intervention or surgical treatment was required,the ICA examination was positive;in the experimental group,the CTA examination was completed through the green channel first.If the CTA showed that the main coronary artery and its main branches were severe or extreme stenosis,further ICA examination was arranged;otherwise,a secondary prophylactic drug treatment was developed and the patients were then discharged and followed up for 1 year.ICA number,ICA positive rate,length of hospital stay,hospital cost,hospital anxiety and depression score(HADS),major cardiovascular events(MACE)within 1 year,and other serious adverse events related to examination or surgery were compared between the two groups.Results A total of 37 patients in the experimental group underwent ICA,and the positive rate of ICA was 94.59%(35/37),which was significantly higher than that of the control group[62.75%(32/51)](P<0.05).The average length of hospital stay and the HADS score before ICA in the experimental group were significantly lower than those in the control group[(3.8±2.2)d vs(4.8±2.4)d;8.8±4.5 vs 11.4±6.8](all P<0.05).There was no significant difference in the cumulative incidence of MACE(3 cases vs 5 cases,P=0.423)and other serious adverse events(8 cases vs 10 cases,P=0.548)within 1 year between the two
作者
沈淑馨
赵宗磊
杜松
石鹏飞
丁守坤
王光公
王丽霞
Shen Shuxin;Zhao Zonglei;Du Song;Shi Pengfei;Ding Shoukun;Wang Guanggong;Wang Lixia(Department of Cardiology,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China;International Medical Center,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第41期3255-3260,共6页
National Medical Journal of China
