期刊
EUROPEAN HEART JOURNAL
卷 23, 期 3, 页码 230-238出版社
OXFORD UNIV PRESS
DOI: 10.1053/euhj.2001.2735
关键词
non-ST-segment elevation myocardial infarction.; early invasive treatment strategy; acute coronary syndromes; coronary angioplasty; coronary artery bypass grafting
Aims Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus. a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. Methods One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). Results All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of pass surgery in 35%. In the conservative the patients and by group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgcry within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2%. vs 22.3% (P<0.001), Six month mortality in the first day angiography/angioplasty group was 3.1%, vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs 14.9% (P<0.02). Conclusions First day coronary angioraphy followed by 9 angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy. (C) 2001 The European Society of Cardiolody.
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