非ST段抬高型急性冠状动脉综合征常规行有创血管造影的时机与远期预后——FRISC II、ICTUS和RITA-3临床研究的个体患者数据的综合分析

目的：本研究旨在探讨接受常规有创处理的非ST 段抬高型急性冠状动脉综合征（non–ST-segment elevation acute coronary syndrome，nSTE-ACS）患者进行早期或延迟血管造影后的远期预后。

背景： 目前关于nSTE-ACS 患者进行血管造影术的最佳时机仍存争议。

方法：汇总FRISC II（Fragmin and Fast Revascularization During Instability in Coronary Artery Disease，冠状动脉疾病不稳定期法安明和快速血运重建）、ICTUS（Invasive Versus Conservative Treatment in Unstable Coronary Syndromes，不稳定型冠状动脉综合征有创与保守治疗）和RITA-3（Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction，不稳定型心绞痛或非ST 抬高型心肌梗死患者介入与保守治疗策略）研究数据，评价该数据库（FIR）中nSTE-ACS 患者早期（2天内）与延迟（3 至5 天内）进行血管造影术后的长期随访资料。主要终点是5 年随访期内的心血管死亡或心肌梗死。用Cox 回归模型计算风险比（hazard ratio，HR）。采用逆概率加权法对FIR 风险评分、研究以及促使接受早期血管造影术的各种倾向进行校正。

结果：在最初被随机分入常规有创组的2721 例患者（包括常规血管造影和随后需要血运重建的患者）中，975 例接受早期血管造影术，1141 例接受延迟血管造影术。Cox 回归模型未观察到两组间在5 年心血管死亡或心肌梗死方面存在差异[ 未校正的HR：1.06，95% 可信区间（confidence interval，CI）： 0.79~1.42，p = 0.61；校正的HR ：0.93，95% CI ：0.75~1.16，p = 0.54]。

结论：在FIR 数据库的nSTE-ACS 患者中，血管造影术的时机与远期心血管死亡和心肌梗死均不相关。[Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS); ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction (the Third Randomised Intervention Treatment of Angina Trials, RITA-3); ISRCTN07752711]

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(J Am Coll Cardiol Intv 2012;5:191–9) © 2012 by the American College of Cardiology Foundation
（韩江莉 翻译，郭丽君 宋治远 审校）