辽宁地区非ST段抬高性急性冠脉综合征诊治现状调查、预后因素分析及治疗策略研究
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摘要
前言
1996年发表的ACC／AHA急性心肌梗死治疗指南中首次使用了“急性冠状动脉综合征(Acute coronary syndromes，ACS)”这一术语，ACS的现代分类：目前主要是根据心电图ST段是否抬高而将其分成ST段抬高的ACS和非ST段抬高ACS。前者绝大多数为ST段抬高心肌梗死(ST-elevation Acute myocardial infarction，STEMI)，后者包括不稳定型心绞痛(Unstable angina，UA)和非ST段抬高心肌梗死(Non-ST-elevation Acute myocardial infarction NSTEMI)。是发达国家及我国人群致死、致残的主要原因之一。因非ST段抬高性ACS患者的人数不断增加，这些趋势要求增强预防和进一步更新诊断及治疗策略，对降低心血管不良事件，改善患者预后具有重要的临床意义，同时越来越成为心血管界学者研究的热点。
随着循证医学的发展和对冠状动脉粥样硬化发生机制研究深入，越来越多的研究关注除传统预后因素以外的预后因素，但是还缺少多中心研究的临床实验的证实，以及关于各种因素对非ST段抬高性急性冠脉综合征患者预后程度如何仍存在不同的意见。
对于非ST段抬高性急性冠脉综合征患者，有两种血运重建策略。一种是积极的策略，另一种是保守策略。近几年随着辽宁的经济能力增强和介入治疗技术的普及，有能力做介入治疗医院越来越多，随之有更多的患者选择介入治疗，那么介入治疗对患者的受益如何?特别是早期的介入治疗对患者的受益程度怎样?并且在另外我省的医院尚未开展使用血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂情况下，介入治疗的结果又如何?这就需要在我省范围内开展非ST段抬高性急性冠脉综合征患者预后因素分析和治疗策略研究。本课题旨在辽宁地区非ST段抬高性急性冠脉综合征诊治现状调查、预后因素分析及治疗策略研究，所做的研究势在必行，关系到辽宁地区非ST段抬高性急性冠脉综合征患者真正的切身利益。
目的
本试验研究辽宁地区非ST段抬高性急性冠脉综合征诊治现状、预后因素及治疗策略，为医师在诊治NSTEACS时及制定合理治疗方案提供循证医学依据。
方法
一、临床资料
连续入选2006年3月-2007年1月间10个城市14家三级及二级医院的非ST段抬高性急性冠脉综合征患者，填写调查表，并于出院后30天、100天和180天随访，获得完整资料900份。将连续入选NSTEACS患者，根据治疗策略的不同分为两组：介入治疗组和单纯药物治疗组。介入治疗组又分为两组：入院48小时内介入治疗组和入院48小时后介入治疗组。
二、观察指标
患者的基线特征、临床干预和终点事件。计量资料符合正态分布者采用均数±标准差，计数资料采用构成比进行描述。预后分析：使用Cox回归模型进行单因素和多因素分析，构建回归方程。比较不同的治疗组患者的临床特征、随访期间出现的心脏事件及不同时间段使用药物情况是否有统计学差异，计量资料使用成组t检验，计数资料使用卡方检验。以死亡为主要事件，以充血性心力衰竭、再次心绞痛发作、心肌梗塞、再次因心脏病住院为次要事件。
三、随访结果分析
不同治疗策略组使用Kaplan-Meier法估计生存率，描记生存曲线。预后因素分析：对死亡终点事件进行Cox模型多因素回归分析，建立回归方程。临床变量对次要心血管事件的影响采用多因素logistic回归分析方法，p＜0.05表示差异有统计学意义。
结果
1、患者诊治现状
900例入选患者基线特征：病人平均年龄64.7岁±11.0岁，其中男533例(59.1％)。入院诊断不稳定性心绞痛732例(81.3％)，急性非ST段抬高性心肌梗死168例(18.7％)。20.9％患者既往有心肌梗死病史、13.7％曾有心力衰竭史；在传统的危险因素中以高血压、高胆固醇、高甘油三酯、高血糖多见；特殊检查和介入治疗情况：入院后有34.2％NSTEACS患者做了冠脉造影，在这些冠脉造影检查患者中73.3％做了PCI。随访期间心脏事件：随访6个月死亡率4.9％；非致死性心肌梗死发生率2.4％、心绞痛75.6％、心衰22.2％、因心脏病再次入院率16％；不同时间段药物使用情况：住院期间应用抗血小板药物、硝酸酯制剂、低分子肝素、β阻滞剂、转换酶抑制剂均占半数以上，出院后药物治疗率呈逐渐下降态势。
二、预后因素分析
Cox逐步回归分析筛选影响死亡终点发生的预后因素，其中风险因子有6项：入院时检测肌钙蛋白升高、CK-MB升高≥正常2倍、白细胞计数升高、纤维蛋白原升高、住院期间心跳过快、发作心绞痛；另外4项是保护因素：入院前2周应用普通肝素、低分子肝素、住院期间应用钙拮抗剂、出院1个月应用阿司匹林；不同性别的生存曲线图表明，随着时间增加生存率下降，出院后124天内女性的生存率低于男性，125天后女性高于男性；多变量Logistic回归分析影响次要心血管事件的风险因子是：年龄、既往有中风病史、心衰、家族史、吸烟史、住院期间发生脑卒中、发热、心率加快、心衰、白细胞计数增高、入院时纤维蛋白原升高和出院3个月发作心绞痛；保护因子是：入院即刻介入治疗、入院前2周应用他汀、氯吡格雷、血管紧张素受体拮抗剂、住院期间应用普通肝素、氯吡格雷、β阻滞剂、出院1个月应用阿司匹林及血管转换酶抑制剂、出院后3个月应用氯吡格雷。
三、入院48小时内介入治疗组与48小时后介入治疗组出院后6个月生存率比较
入院48小时内介入治疗组生存率高于48小时后介入治疗组，但两组比较无显著统计学差异。
结论
1、辽宁地区就诊的非ST段抬高的急性冠脉综合征患者以不稳定心绞痛居多，随访期间发生心血管事件主要是反复缺血性心绞痛、心衰。
2、在非ST段抬高的急性冠脉综合征患者的危险因素中以高血压病、高甘油三酯、高血糖为主，高于我国此类患者危险因素构成。
3、肌钙蛋白、白细胞计数升高、入院时检测CK-MB升高≥正常2倍、纤维蛋白原升高、住院期间心跳过快、住院期间发作心绞痛、发生心衰是非ST抬高性ACS患者出院后发生死亡事件的独立预测因子。
4、出院后6个月内随着时间增加生存率下降，在出院后124天内女性的生存率低于男性，125天后女性高于男性。
5、入院后即刻介入治疗减少非ST抬高性ACS患者非致命性心肌梗死的发生率。
6、接受介入治疗的非ST段抬高性急性冠脉综合征患者出院后服用药物依从性好，明显优于单纯药物治疗的患者。
7、在辽宁地区具有本地域疾病特点、未使用血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂情况下，入院48小时内的介入治疗与入院后48小时后的介入治疗对非ST抬高性ACS患者的出院后6个月的生存时间的影响无明显差别，远期的结果有待于进一步观察。
A Survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, an Analysis of Prognosis Factors and Study of treatment in region of Liaoning
Introduction
The technical term of Acute coronary syndromes (ACS) was used first time in the therapia guide of Acute myocardial infarction of the ACC/AHA publication in 1996. Modem classification of ACS is ST-elevation Acute coronary syndromes and Non-ST-elevation Acutecoronary syndromes.The former is ST-elevation Acute myocardial infarction (STEMI) and the latter is Unstable angina (UA) and Non-ST-elevation Acute myocardial infarction (NSTEMI).ACS is one of the causes of death and mutilation in the developed country and our country. Because of continue increasing of the number of patients these tendencies request to strengthen for prevention and chang diagnosis and theapia strategies in order to decrease heart-blood dysevents and have many clinical significance to improve prognosis, and meantime these had been investigative hot topics of scholars
With development of evidence-based medicine's basis and generate mechanism of coronary atherosclerosis more and more studies pay attention for prognosis factors except traditional factors, but there is short of withness of multi- central research,and moreover there are many different views for various factors to affect prognisis degree
There are two revascularization to patients of non-ST-elevation Acutecoronary syndromes. The first is energetic strategy and the second is conservative strategy
With reinforce of ability of region of Liaoning and popular of interventional therapy more and more hospitals have ability to do interventional therapy and more patients choose this treatment, but we do not know the degree of profit. In this status we develop to study survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to know ture patiental immediate interests without GPⅡb/Ⅲa.
Objective
This test aim to survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to offer evidence-based medicine's basis while physician make a diagnosis and give treatment to NSTEACS.
Methods
1、Clinic data: choose successively patients suffered from NSTEACS initially in 14 third-class or second-class hospitals in 10cities from March 2006-January 2007, filled in questionaire and had a follow-up when the patients disdischarged from hospital after 30 days, 100 days, and 180 days, then got complete 900 data. All patients were divided into two groups by different treatment strategies: group of interventional therapy and group of drug treatment. Group of interventional therapy was separated into two groups: group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.
2、Observational target: Include the patients' characters of base line, clinical interference measure and end point events. The people whose measurement data were shown as average standard deviation .Enumeration count data is described as constitute ratio. Compared if the characters of base line has the statistical discrepancy of the patient in different groups; Measurement data is checked up as the whole group t test; Enumeration count data is checked up as x~2 test. The key event is death and second events were nonfatal myocardial infarct, reangina pectoris attacks, congestive cardiac failure, in-hospital again because heart disease.
3、Analyzed results of follow-up: Used Kaplan-Meier survival analytical method to estimate survival rate and trace survival curve. Analyzed prognosis factors: Used Cox proportional hazards recreation model to have single factor and multi-factor analysis, and composed regression equation. Adopted multiple factors logistic regression analysis to analyze the influence of various clinical variances to second events. When p≤0.05,there were statistical significance of discrepancy.
Result
1、Current practice of patients: the patients' characters of base line: mean age of patient was 64.7±11.0 years , and proportion of male patients was 59.1%; the percentage of UA was 81.3%,and NSTEMI was 18.7%. 20.9% of patients had history of myocardial infarct in the past, and 13.7% had history of congestive cardiac failure. there were more patients of high blood pressure, high cholesterol, high triglyceride and hyperglycosemia than other patients in all orthodox risk factors. The status of special check and interventional therapy: 34.2% of patients was checked coronary angiography, and 73.3% in these patients was performed PCI. there were 49.5%of PCI patients were performed in 48 hours after admission. The heart event in follow-up period: Death rate was 4.9% in follow-up six months; The incidence rate of nonfatal myocardial infarct was 2.4%, reangina pectoris attacks 75.6%, congestive cardiac failure 22.2%, in-hospital again because heart disease 16.0%. The status of drug use in different period: The apply rates of antiplatelet drug, nitrate, Low Molecular Heparin,βblock agent and angeial convering enzyme inhibitor were above 50%, but the rate of drug treatment tend to descend out of hospital.
2、Prognosis factors analysis : prognosis factors of shorten survival time were high troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeats, reangina pectoris attacks in hospital, there were four prognosis factors to lengthen survival time, such as applying common heparin two week before admission, Low Molecular Heparin, using calcium antagonist in hospital, aspillini one month after admission. Survival curve indicate: survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in disdischarge 124 days, but higher after 125 days. Risk factors which affected second event by multi variable Logistic regression analysis were fever in hospital : age, history of plasy, congestive cardiac failure and smoking in the past, family history, incidence of cerebral accident, fever, fast heartbeat, congestive cardiac failure, high lencocyte count, high fibrinogen, reangina pectoris attacks in discharge three month;protect factors were interventional therapy at once after admission, using drug such as stain, clopidogrel, calcium antagonist for two week before admission, utilizing common heparin, clopidogrel,βblock agent in hospital and using clopidogrel in discharge three months.
3、Compared survival rate in different therapy groups: survival rate in group of interventional therapy in 48 hours was higher than that of, but there was not different between the group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.
Conclusion
1、The patients of unstable angina were more than that of Non-ST-elevation Acute myocardial infarction. The events of unstable angina and congestive cardiac failure were more than other events
2、Incidence rate of high blood pressure, high triglyceride and hyperglycosemia is higher than that of our country。
3、High troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeat, reangina pectoris attacks in hospital were independent prognosis factors.
4、Survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in discharge 124 days, but higher after 125 days.
5、Interventional therapy at once reduce incidence rate of myocardial infarct.
6、Compliance of patients in interventional therapy group were much better than that durg therapy group.
7、There was no effect to survival time of discharge 6 months between the group of interventional therapy in 48 hours and the group of interventional therapy after 48 hours, with feature of local region of Liaoning.and without GPⅡb/Ⅲa, and future results are needed to explorate by going on follow-up.
1996年发表的ACC／AHA急性心肌梗死治疗指南中首次使用了“急性冠状动脉综合征(Acute coronary syndromes，ACS)”这一术语，ACS的现代分类：目前主要是根据心电图ST段是否抬高而将其分成ST段抬高的ACS和非ST段抬高ACS。前者绝大多数为ST段抬高心肌梗死(ST-elevation Acute myocardial infarction，STEMI)，后者包括不稳定型心绞痛(Unstable angina，UA)和非ST段抬高心肌梗死(Non-ST-elevation Acute myocardial infarction NSTEMI)。是发达国家及我国人群致死、致残的主要原因之一。因非ST段抬高性ACS患者的人数不断增加，这些趋势要求增强预防和进一步更新诊断及治疗策略，对降低心血管不良事件，改善患者预后具有重要的临床意义，同时越来越成为心血管界学者研究的热点。
随着循证医学的发展和对冠状动脉粥样硬化发生机制研究深入，越来越多的研究关注除传统预后因素以外的预后因素，但是还缺少多中心研究的临床实验的证实，以及关于各种因素对非ST段抬高性急性冠脉综合征患者预后程度如何仍存在不同的意见。
对于非ST段抬高性急性冠脉综合征患者，有两种血运重建策略。一种是积极的策略，另一种是保守策略。近几年随着辽宁的经济能力增强和介入治疗技术的普及，有能力做介入治疗医院越来越多，随之有更多的患者选择介入治疗，那么介入治疗对患者的受益如何?特别是早期的介入治疗对患者的受益程度怎样?并且在另外我省的医院尚未开展使用血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂情况下，介入治疗的结果又如何?这就需要在我省范围内开展非ST段抬高性急性冠脉综合征患者预后因素分析和治疗策略研究。本课题旨在辽宁地区非ST段抬高性急性冠脉综合征诊治现状调查、预后因素分析及治疗策略研究，所做的研究势在必行，关系到辽宁地区非ST段抬高性急性冠脉综合征患者真正的切身利益。
目的
本试验研究辽宁地区非ST段抬高性急性冠脉综合征诊治现状、预后因素及治疗策略，为医师在诊治NSTEACS时及制定合理治疗方案提供循证医学依据。
方法
一、临床资料
连续入选2006年3月-2007年1月间10个城市14家三级及二级医院的非ST段抬高性急性冠脉综合征患者，填写调查表，并于出院后30天、100天和180天随访，获得完整资料900份。将连续入选NSTEACS患者，根据治疗策略的不同分为两组：介入治疗组和单纯药物治疗组。介入治疗组又分为两组：入院48小时内介入治疗组和入院48小时后介入治疗组。
二、观察指标
患者的基线特征、临床干预和终点事件。计量资料符合正态分布者采用均数±标准差，计数资料采用构成比进行描述。预后分析：使用Cox回归模型进行单因素和多因素分析，构建回归方程。比较不同的治疗组患者的临床特征、随访期间出现的心脏事件及不同时间段使用药物情况是否有统计学差异，计量资料使用成组t检验，计数资料使用卡方检验。以死亡为主要事件，以充血性心力衰竭、再次心绞痛发作、心肌梗塞、再次因心脏病住院为次要事件。
三、随访结果分析
不同治疗策略组使用Kaplan-Meier法估计生存率，描记生存曲线。预后因素分析：对死亡终点事件进行Cox模型多因素回归分析，建立回归方程。临床变量对次要心血管事件的影响采用多因素logistic回归分析方法，p＜0.05表示差异有统计学意义。
结果
1、患者诊治现状
900例入选患者基线特征：病人平均年龄64.7岁±11.0岁，其中男533例(59.1％)。入院诊断不稳定性心绞痛732例(81.3％)，急性非ST段抬高性心肌梗死168例(18.7％)。20.9％患者既往有心肌梗死病史、13.7％曾有心力衰竭史；在传统的危险因素中以高血压、高胆固醇、高甘油三酯、高血糖多见；特殊检查和介入治疗情况：入院后有34.2％NSTEACS患者做了冠脉造影，在这些冠脉造影检查患者中73.3％做了PCI。随访期间心脏事件：随访6个月死亡率4.9％；非致死性心肌梗死发生率2.4％、心绞痛75.6％、心衰22.2％、因心脏病再次入院率16％；不同时间段药物使用情况：住院期间应用抗血小板药物、硝酸酯制剂、低分子肝素、β阻滞剂、转换酶抑制剂均占半数以上，出院后药物治疗率呈逐渐下降态势。
二、预后因素分析
Cox逐步回归分析筛选影响死亡终点发生的预后因素，其中风险因子有6项：入院时检测肌钙蛋白升高、CK-MB升高≥正常2倍、白细胞计数升高、纤维蛋白原升高、住院期间心跳过快、发作心绞痛；另外4项是保护因素：入院前2周应用普通肝素、低分子肝素、住院期间应用钙拮抗剂、出院1个月应用阿司匹林；不同性别的生存曲线图表明，随着时间增加生存率下降，出院后124天内女性的生存率低于男性，125天后女性高于男性；多变量Logistic回归分析影响次要心血管事件的风险因子是：年龄、既往有中风病史、心衰、家族史、吸烟史、住院期间发生脑卒中、发热、心率加快、心衰、白细胞计数增高、入院时纤维蛋白原升高和出院3个月发作心绞痛；保护因子是：入院即刻介入治疗、入院前2周应用他汀、氯吡格雷、血管紧张素受体拮抗剂、住院期间应用普通肝素、氯吡格雷、β阻滞剂、出院1个月应用阿司匹林及血管转换酶抑制剂、出院后3个月应用氯吡格雷。
三、入院48小时内介入治疗组与48小时后介入治疗组出院后6个月生存率比较
入院48小时内介入治疗组生存率高于48小时后介入治疗组，但两组比较无显著统计学差异。
结论
1、辽宁地区就诊的非ST段抬高的急性冠脉综合征患者以不稳定心绞痛居多，随访期间发生心血管事件主要是反复缺血性心绞痛、心衰。
2、在非ST段抬高的急性冠脉综合征患者的危险因素中以高血压病、高甘油三酯、高血糖为主，高于我国此类患者危险因素构成。
3、肌钙蛋白、白细胞计数升高、入院时检测CK-MB升高≥正常2倍、纤维蛋白原升高、住院期间心跳过快、住院期间发作心绞痛、发生心衰是非ST抬高性ACS患者出院后发生死亡事件的独立预测因子。
4、出院后6个月内随着时间增加生存率下降，在出院后124天内女性的生存率低于男性，125天后女性高于男性。
5、入院后即刻介入治疗减少非ST抬高性ACS患者非致命性心肌梗死的发生率。
6、接受介入治疗的非ST段抬高性急性冠脉综合征患者出院后服用药物依从性好，明显优于单纯药物治疗的患者。
7、在辽宁地区具有本地域疾病特点、未使用血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂情况下，入院48小时内的介入治疗与入院后48小时后的介入治疗对非ST抬高性ACS患者的出院后6个月的生存时间的影响无明显差别，远期的结果有待于进一步观察。
A Survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, an Analysis of Prognosis Factors and Study of treatment in region of Liaoning
Introduction
The technical term of Acute coronary syndromes (ACS) was used first time in the therapia guide of Acute myocardial infarction of the ACC/AHA publication in 1996. Modem classification of ACS is ST-elevation Acute coronary syndromes and Non-ST-elevation Acutecoronary syndromes.The former is ST-elevation Acute myocardial infarction (STEMI) and the latter is Unstable angina (UA) and Non-ST-elevation Acute myocardial infarction (NSTEMI).ACS is one of the causes of death and mutilation in the developed country and our country. Because of continue increasing of the number of patients these tendencies request to strengthen for prevention and chang diagnosis and theapia strategies in order to decrease heart-blood dysevents and have many clinical significance to improve prognosis, and meantime these had been investigative hot topics of scholars
With development of evidence-based medicine's basis and generate mechanism of coronary atherosclerosis more and more studies pay attention for prognosis factors except traditional factors, but there is short of withness of multi- central research,and moreover there are many different views for various factors to affect prognisis degree
There are two revascularization to patients of non-ST-elevation Acutecoronary syndromes. The first is energetic strategy and the second is conservative strategy
With reinforce of ability of region of Liaoning and popular of interventional therapy more and more hospitals have ability to do interventional therapy and more patients choose this treatment, but we do not know the degree of profit. In this status we develop to study survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to know ture patiental immediate interests without GPⅡb/Ⅲa.
Objective
This test aim to survey of Current Practice for Non-ST-segment elevation Acute coronary syndromes, analyze of Prognosis Factors and study of treatment in region of Liaoning to offer evidence-based medicine's basis while physician make a diagnosis and give treatment to NSTEACS.
Methods
1、Clinic data: choose successively patients suffered from NSTEACS initially in 14 third-class or second-class hospitals in 10cities from March 2006-January 2007, filled in questionaire and had a follow-up when the patients disdischarged from hospital after 30 days, 100 days, and 180 days, then got complete 900 data. All patients were divided into two groups by different treatment strategies: group of interventional therapy and group of drug treatment. Group of interventional therapy was separated into two groups: group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.
2、Observational target: Include the patients' characters of base line, clinical interference measure and end point events. The people whose measurement data were shown as average standard deviation .Enumeration count data is described as constitute ratio. Compared if the characters of base line has the statistical discrepancy of the patient in different groups; Measurement data is checked up as the whole group t test; Enumeration count data is checked up as x~2 test. The key event is death and second events were nonfatal myocardial infarct, reangina pectoris attacks, congestive cardiac failure, in-hospital again because heart disease.
3、Analyzed results of follow-up: Used Kaplan-Meier survival analytical method to estimate survival rate and trace survival curve. Analyzed prognosis factors: Used Cox proportional hazards recreation model to have single factor and multi-factor analysis, and composed regression equation. Adopted multiple factors logistic regression analysis to analyze the influence of various clinical variances to second events. When p≤0.05,there were statistical significance of discrepancy.
Result
1、Current practice of patients: the patients' characters of base line: mean age of patient was 64.7±11.0 years , and proportion of male patients was 59.1%; the percentage of UA was 81.3%,and NSTEMI was 18.7%. 20.9% of patients had history of myocardial infarct in the past, and 13.7% had history of congestive cardiac failure. there were more patients of high blood pressure, high cholesterol, high triglyceride and hyperglycosemia than other patients in all orthodox risk factors. The status of special check and interventional therapy: 34.2% of patients was checked coronary angiography, and 73.3% in these patients was performed PCI. there were 49.5%of PCI patients were performed in 48 hours after admission. The heart event in follow-up period: Death rate was 4.9% in follow-up six months; The incidence rate of nonfatal myocardial infarct was 2.4%, reangina pectoris attacks 75.6%, congestive cardiac failure 22.2%, in-hospital again because heart disease 16.0%. The status of drug use in different period: The apply rates of antiplatelet drug, nitrate, Low Molecular Heparin,βblock agent and angeial convering enzyme inhibitor were above 50%, but the rate of drug treatment tend to descend out of hospital.
2、Prognosis factors analysis : prognosis factors of shorten survival time were high troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeats, reangina pectoris attacks in hospital, there were four prognosis factors to lengthen survival time, such as applying common heparin two week before admission, Low Molecular Heparin, using calcium antagonist in hospital, aspillini one month after admission. Survival curve indicate: survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in disdischarge 124 days, but higher after 125 days. Risk factors which affected second event by multi variable Logistic regression analysis were fever in hospital : age, history of plasy, congestive cardiac failure and smoking in the past, family history, incidence of cerebral accident, fever, fast heartbeat, congestive cardiac failure, high lencocyte count, high fibrinogen, reangina pectoris attacks in discharge three month;protect factors were interventional therapy at once after admission, using drug such as stain, clopidogrel, calcium antagonist for two week before admission, utilizing common heparin, clopidogrel,βblock agent in hospital and using clopidogrel in discharge three months.
3、Compared survival rate in different therapy groups: survival rate in group of interventional therapy in 48 hours was higher than that of, but there was not different between the group of interventional therapy in 48 hours and group of interventional therapy after 48 hours.
Conclusion
1、The patients of unstable angina were more than that of Non-ST-elevation Acute myocardial infarction. The events of unstable angina and congestive cardiac failure were more than other events
2、Incidence rate of high blood pressure, high triglyceride and hyperglycosemia is higher than that of our country。
3、High troponin, CK-MB≥2 times than normal, high lencocyte count, high fibrinogen, the fast heartbeat, reangina pectoris attacks in hospital were independent prognosis factors.
4、Survival rate decreased with increasing time, and female patients' survival rate was lower than that of male pations in discharge 124 days, but higher after 125 days.
5、Interventional therapy at once reduce incidence rate of myocardial infarct.
6、Compliance of patients in interventional therapy group were much better than that durg therapy group.
7、There was no effect to survival time of discharge 6 months between the group of interventional therapy in 48 hours and the group of interventional therapy after 48 hours, with feature of local region of Liaoning.and without GPⅡb/Ⅲa, and future results are needed to explorate by going on follow-up.
引文
1 Ryan TJ, Anderon JL, Antman EM,et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 1996; 28:1328-428
2 Fox KA, Goodman SG, Anderson FA, et al. From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acutecoronary syndromes. Eur Heart J, 2003; 24: 1414-1424.
3 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG; Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PW, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 18: 338(25): 1785-92
4 胡大一．无ST抬高的急性冠脉综合征更为常见．中华医药杂志．2002；4(1)：30
5 Furberg CD, Psaty BM,Meyer JV. Nifedip ine doserelated increase in mortality in patients with coronary heart disease. Circulation. 1995; 92:1326-1331.
6 谭慧琼，朱俊，梁岩．非ST段抬高的急性冠状动脉综合征二年随访．中华医学杂志．2005；85(3)：184-188
7 Yusuf S, FlatherM, Pogue J, et al. Variations between countries ininvasive cardiac procedures and outcomes in patients with suspectedunstabe angina or myocardial infarction without initial ST elevation. Lancet. 1998,;352: 507-514.
8 Collinson J, FlatherMD, Fox KA, et al. Clinical outcomes, risk stratification and practice patterns of unstable angina and mycardialinfarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRA IS2UK). Eur Heart. 2000; 21: 1450-1457.
9 Stone PH, Thomp son B, Anderson HV, et al. Influence of race,sex, and age on management of unstable angina and non2Q2wavemyocardial infarction: The TIMI Ⅲ Registry. JAMA. 1996; 275:1104-1112.
10 Granger CB. Strategies of patient cwere in acute coronary syndromes:rationals for the Global Registry of Acute Coronary Events (GRACE)registry. Am J Cardiol. 2000; 86 Suppl: 4M-29M.
11 Patrono C,Bachmann F, Baigent C, et al. Expert consensus documenton the use of antip latelet agents: the task force on the use ofantip latelet agents in patients with atherosclerotic cardiovasculardisease of the European society of cardiology. Eur Heart. 2004;25: 166-181.
12 Braunwaid E, Antman EM, Beasley JW, et al. ACC/AHA Guideline update for the management of patientswith unstabe angina and non-STsegment elevation myocardial iarticle. Circulation. 2002; 106:1893-1990.
13 Hjalmarson F, Goldstein S, FagerbergB, et al. Effects of controlled release metop rolol on total mortality, hospitalization, and well beingin patients with heart failure. The metop rolol CR / XL randomizedinternational trial in congestive heart failure (MER IT2HF). JAMA. 2000; 238:1295-1302.
14 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin converting enzyme inhibitor, ramip ril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation Studylnvestigators. N Engl J Med. 2000; 342: 145-153.
15 Furberg CD, Psaty BM,Meyer JV. Nifedip ine doserelated increase in mortality in patients with coronary heart disease. Circulation. 1995; 92: 1326-1331.
16 梁岩，朱俊，谭慧琼等．OASIS登记试验中国地区协作组．中国地区非ST抬高急性冠脉综合征患者生存时间的影响因素分析．中华医学杂志．2005年，85(13)：873-877．
17 Boersma, PhD; Karen S. Pieper, MS; Ewout W. S[1]。Results From an International Trial of 9461 Patients teyerberg. Circulation. 2000;10(1):2557-2562.
18 Predictors of 90-day outcome in patients stabilized after acute coronary syndromes., Bhapkar MV, White HD, Topoi EJ, Dougherty FC, Harrington RA, Smith MC, Asarch LF, Califf RM; SYMPHONY and 2nd SYMPHONY Investigators. Eur Heart. 2003; 24(2): 172-181.
19 赵明中，胡大一，许玉韵，等1心电图变化及肌钙蛋白水平对非ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值 中华心血管病杂志．2003；31：568-572．
20 Ridker PM, Cook N1 Clinical usefulness of very high and very lowlevels of C-reactive protein across the full range offraminlgham riskscoresl. Circulation. 2004; 109: 1955-1959.
21 Cannon CP, McCabe CH, Stone PH, et allFor the TIMI Ⅲ Registry ECG Ancillary Study Investigators1 The electrocardiogram predicts One year outcome of patients with unstable angina and non-Q wave myocardial infarction: Results of the TIM I Ⅲ Registry ECG Ancillary Study. Am Coll Cardiol. 1997;30:1 33-140.
22 Mehta J L, Saldeen T G, Rand K. Interactive role of infection, inflammation and traditional risk factors in atherosclerosis and coronary artery disease. Am Coll Cardiol. 1998; 31(6): 1217-1222.
23 Kosar F, Varol E, Ayaz S, et al. Plasma leukocyte elastaseconcentration and coronary artery disease. Angiology. 1998; 49(3): 193-199.
24 Brown D W, Giles W H, Croft J B et al. White blood cellcount: an independent predictor of coronary heart disease mortalityamong a national cohort. Clin Epidemiol. 2001; 54(3): 316-319.
25 李建军．白细胞增多在急性心肌梗塞发生中的作用．天津医药．1991；7：444
26 Hajj,Ali R, ZwerebaW, Ezzeddine R, et al. Relation of the leukocyte count to recurrent cardiac events in stable patients after acutemyocardial infarction. Am J Cardiol. 2001; 88:1221-1224.
27 Barron HV, Hart SD, Radford MJ, et al. The association between white blood cell count and acute myocardial infarction mortality inpatients ≥ 65 years of age: findings from the cooperative cardiovascular project. Am Coll Cardiol. 2001; 38:1654 - 1661.
28 王雪青．纤维蛋白(原)在动脉粥样硬化发病中的作用及机．生理科学进展．1996；27(3)：245—248．
29 Ward DJ, Taylor. Guidelines for acute coronary syndrome without ST elevation.Lancet. 2002;35(9): 1340-1344.
30 Warmamethee G, Shaper AG, Macfarlane PW, et al. Risk factors for sudden death inmidde-aged British men. Circulation. 1995; 91: 1749-1753.
31 Newby LK, Bhapkar MV, White HD, et all Predictors of 90-dayoutcome in patients stabilized after acute coronary syndromes1. EurHeart. 2003; 24: 172-181
32 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PWOutcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 18(25): 1785-1792.
33 Yusuf S, FlatherM, Pogue J, et al. Variations between countries ininvasive cardiac p rocedures and outcomes in patients with suspectedunstabe angina or myocardial infarction without initial ST elevation. Lancet. 1998; 352: 507-514.
34 The FRISC II Investigators. Invasive compared with non-invasivetreatment in unstable coronary artery disease: FRISC II prospectiverandomised multicentre study. Lancet. 1999 ;354:708-715..
35 Gibson CM, Cannon CP.Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment. Circulation. 2005; 111(10):1217-24.
36 Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, McCabe CH, Braunwald E, Gibson CM.Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarction 18 trial)substudy. Am Coll Cardiol. 2002; 40(10): 1761-1768.
37 Lagerqvist B, Diderholm E, Lindahl B, Husted S, Kontny F, Stahle E, Swahn E, Venge P, Siegbahn A, Wallentin LFRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005; 91(8):1047-1052.
38 Janzon M, Levin LA, Swahn E(?)nvasive treatment in unstable coronary artery disease promotes health-related quality of life: results from the FRISC II trial. Am Heart. 2004; 148(1):114-121
39 Januzzi JL Jr, Buros J, Cannon CP; Tactics TIMI 18 InvestigatorsPeripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial. Clin Cardiol. 2005; 28(5):238-242.
40 McCullough PA, Gibson CM, Dibattiste PM, Demopoulos LA, Murphy SA, Weintraub WS, Neumann FJ, Khanal S, Cannon CP; TACTICS-TIMI-18 Investigators.Timing of angiography and revascularization in acute coronary syndromes: an analysis of the TACTICS-TIMI-18 trial. J Interv Cardiol. 204 ; 17(2):81-86.
41 Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, Knight R, Pocock SJ.5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005; 366: 914-920.
42 赵明中，胡大一，姜立清，非ST段抬高急性冠状动脉综合征的危险因素分析及早期干预，中华心血管病杂志．2005；33(2)：153—155．
1 Pollack CV Jr, Roe MT, Peterson ED. 2002 Update to the ACC/AHAguidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med. 2003;41:355-369.
2 Koukkunen H, K Pyorala and OHM. Low-risk patients with chest pain and with evidence of myocardial infarction may be safely disdischarged from emergency deparment. Eur Heart. 2004; 25(4): 329-334.
3 Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2004; 93(3): 288-293.
4 Sabatine MS, McCabe CH, Morrow DA, et al. Identification of patients at high risk for death and cardiac ischemic events after hospital disdischarge. Am Heart. 2002; 143(6): 966-970.
5 Koukkunen H, K Pyorala and O H M. Low-risk patients with chest pain and without evidence ofmyocardial infarction may be safely disdischarge from emergency department. Eur Heart. 2004; 25(4): 329-334.
6 Boersma, PhD; Kweren S. Pieper, MS; Ewout W. S[l]o Results From an International Trial of 9461 Patients teyerberg, PhD; Robert G. Wilcox, MD; Wei-Ching Chang, PhD; Kerry L. Lee, PhD; K. Martijn Akkerhuis, MD; Robert A. Harrington, MD; Jaap W. Deckers, MD; Paul W. Armstrong, MD; A. Michael Lincoff, MD; Robert M. Califf, MD; Eric J. Topol, MD; Maarten L. Simoons, MD; Circulation. 2000;101:2557-2562.
7 Predictors of 90-day outcome in patients stabilized after acute coronary syndromes., Bhapkar MV, White HD, Topol EJ, Dougherty FC, Harrington RA, Smith MC, Asarch LF, Califf RM; SYMPHONY and 2nd SYMPHONY Investigators. Eur Heart J. 2003; 24(2):172-181.
8 Hubbard BL, et al. Prospective evaluation of a clinical and exercise-test model for the prediction of left main coronary artery disease. Ann Interm MED 1993; 22 :118-123.
9 Eric Boersma, PhD; Kweren S. Pieper, MS; Ewout W. Steyerberg, PhD; Robert G. Wilcox, MD; Wei-Ching Chang, PhD; Kerry L. Lee, PhD; K. Martijn Akkerhuis, MD; Robert A. Harrington, MD; Jaap W. Deckers, MD; Paul W. Armstrong, MD; A. Michael Lincoff, MD; Robert M. Califf, MD; Eric J. Topol, MD; Maarten L. Simoons, MD; for the Investigators Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation. Circulation. 2000; 101:2557-2561.
10 Holmes DRJ, White HD, Pieper F, Ellis SG, Califf RM, Topol EJ. Effect of age on outcome with primary angioplasty versus thrombolysis . AM coll Cardiol 1999; 33:412-419.
11 White HD, Bash GI, Calliff RM, et al. Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-1 trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial.. Circulation. 1996; 94:1826-1833.
12 Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet JP; GRACE Investigatorslmpact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE).. Am Heart. 2005; 149(1): 67-73.
13 Alexander KP, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Foody JM, Boden WE, Smith SC Jr, Gibler WB, Ohman EM, in cardiovascular cwere for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative.Peterson ED; CRUSADE Investigators. Am Coll Cardiol. 2005; 46(8): 1479-87.
14 Boersma, PhD; Kweren S. Pieper, MS; Ewout W. Steyerberg, PhD; Robert G. Wilcox, MD; Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation. Circulation. 2000; 101:2557-2564.
15 Timoteo AT, Ferreira J, Aguiar C, Almeida Mde S, Ribeiro MA, Cavaco DM, Trabulo M, Seabra-Gomes R Revascularization and prognosis in female patients with non-ST-segment elevation acute coronary syndromes. Rev Port Cardiol. 2003; 22(3):367-374.
16 Bruce D. Klugherz,MD,Nicolas F.Meneveau, MD, Daniel M.Kolansky,MD,et al. Predictors of clinical outcome following percutaneous intervention for in-stent restenosis.AM J Cardiol. 2000; 85:1427-1431.
17 Theodore A.Bass,MD.Post-PCI Cardiac events? The answer is the lumen ,or is it in the wall?.cCatherterization and cardiovascular interventions. Arch Inst Cardiol Mex. 2002; 55:338-339.
18 Semenkovich CF, Heinfche JW. Perspective in diabetes: the mystery of diabetes and atherosclerosis. Diabetes ,. 1997; 46: 327-334.
19 代政学，贾国良，李兰荪，等．伴有非胰岛素依赖型糖尿病冠心病患者冠状动脉病变和临床特征分析．第四军医大学学报．1999；20：2．
20 Lerman GL, Abumada AM, Posadas RC. The heart and diabetes mellitus. Arch Inst Cardiol Mex. 1990; 60:79-84.
21 Peter Mazeika, MD,Neeraj Prasad,MD,Sanh Bui,BSc, peter H.Seide lin, MD, FACC.Predictors of angiographic restenosis after coronary intervention in patient with diabetes mellitus.AM Heart. 2003; 145:1013-1021.
22 Brogan GX Jr, Peterson ED, Mulgund J, Bhatt DL, Ohman EM, Gibler WB, Pollack CV Jr, Farkouh ME, Roe MT.Treatment Disparities in the Cwere of Patients With and Without Diabetes Presenting With Non-ST-Segment Elevation Acute Coronary Syndromes.Diabetes Cwere. 2006; 29(1):9-14.
23 Willerson JT. Editor, scommentary: center of excellence. Circulation. 2003; 107:1471-2
24 Chochola M, Linhart A. Epidemiology of peripheral arterial occlusive disease. Cas Lek Cesk. 2006; 145(5):368-370.
25 Celven AH, Kesster AD, Hooi JD, Knottnerus JA Cardiovascular outcome stratification using the ankle-brachial pressure index. Eur J Gen Pract. 2005; 11(3-4):107-112.
26 Januzzi JL Jr, Buros J, Cannon CP; Tactics TIMI 18 Investigators. Peripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial. Clin Cardiol. 2005; 28(5):238-242.
27 Holmvang L, Luscher MS, Clemmensen P, et al. Very earlyrisk stratification using combined ECG and biochemical assess-ment in patients with unstable coronary artery disease. Circula-tion. 1998; 98: 2004-2009.
28 Zhao MZ, Hu DY, Zhang FC, Wu Y, Yan MY, Wang SW, Mao JM, Yang M, Jiang LQ.The changes of electrocardiogram and impact of early invasive strategy in patients with acute coronary syndromes without ST-segment elevation] Zhonghua Yi Xue Za Zhi. 2005; 85(13):879-882.
29 Savonitto S, Cohen MG, Politi A, Hudson MP, Kong DF, Huang Y, Pieper KS, Mauri F, Wagner GS, Califf RM, Topol EJ, Granger CBExtent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. Eur Heart. 2005; 26(20):2106-2113.
30 Kosuge M, Kimura K, Ishikawa T, Ebina T, Shimizu T, Hibi K, Toda N, Tahara Y, Tsukahara K, Kanna M, Okuda J, Nozawa N, Ozaki H, Yano H, Umemura SPredictors of left main or three-vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation. Am J Cardiol. 2005; 95(11):1366-1369.
31 Antman EM ,Petersen JL, Mahaffey KW, Hasselblad V, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: a systematic overview.. 2004; 292(1):89-96.
32 Sabatine MS, McCabe CH, Morrow DA, et al. Identification of patients at high risk for death and cardiac ischemic events after hospital disdischarge. Am Heart. 2002; 143(6): 966-970
33 Miwako Shihara,MD, Hiroyuki Tsutsui, MD, Miyuki Tsuchiashi,MS. In-hispital and one-year outcomes for pations undergoing percutaneous coronary intervention for acute myocardial infarction. AM J Cardiol. 2002; 90:932-936
34 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation, 2003;108: 533-535.
35 Collet JP, Montalescot G, Agnelli G, Van de Werf F, Gurfinkel EP, Lopez-Sendon J, Laufenberg CV, Klutman M, Gowda N, Gulba D; GRAC E InvestigatorsNon-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events.. Eur Heart. 2005; 26(21):2285-2293.
36 Santopinto JJ, Fox KA, Goldberg RJ, Budaj A, Pinero G, Avezum A, Gulba D, Esteban J, Gore JM, Johnson J, Gurfinkel EP; GRACE InvestigatorsCreatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE).. Heart. 2003; 89(9):1003-1008.
37 Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, Granger CB, Ohman EM, Holmes DR Jr; GUSTO-IIb, GUSTO-III, PURSUIT. Global Use of Strategies to Open Occluded Coronary Arteries. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy; PARAGON-A Investigators. Platelet Ilb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization NetworkPrognostic implications of abnormalities in renal function in patients with acute coronary syndromes. J Am Coll Cardiol. 2004; 23:234-245.
38 de Lemos JA, Morrow DA, Gibson CM, Murphy SA, Sabatine MS, Rifai N, McCabe CH, Antman EM, Cannon CP, Braunwald EThe prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes. Results from the TEMI 11B and TACTICS-TIMI 18 studies. Am Coll Cardiol. 2002; 40(2):238-44..
39 Furman MI, Gore JM, Anderson FA, Budaj A, Goodman SG, Avezum A, Lopez-Sendon J, Klein W, Mukherjee D, Eagle KA, Dabbous OH, Goldberg RJ; GRACE Investigators.Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2004;147(l):42-48.
40 Norbert Frey, MD; Anne Dietz, MD; Volkhard Kurowski, MD; Evangelos Giannitsis, MD; Ralph To" lg, MD;Uwe Wiegand, MD; Gert Richardt, MD; Hugo A. Katus, MD Angiographic correlates of a positive troponin T test in patients with unstable angina. Crit Cwere Med. 2001; 29:.1130-1136.
41 Shmuel Fuch, MD, luis Gruberg, MD,Sandeep Singh,MD, et al.Prognostic value of cardiac teoponin I re-elevation following percutaneous coronary intervention in high-risk patient with actue coronary syndromes. AM J Cardiol 2001;88:129-133.
42.Antman EM, Janasijevic MJ , Thompson B , et al. Cardic-specific troponin I levels to predict the risk of mortality in patients withacute coronary syndromes. N Engl J Med. 1996; 335 :1342-1349.
43 Ottani F , Galvani M, Nicolini FA , et al. Elevated cardiac troponin levels predict the risk of adverse outcome in patients withacute coronary syndromes. Am Heart. 2000; 140 :917-927.
44 Newby LK, Christenson RH , Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in paients with acute coronary syndromes. The GUSTO211a Investi-gators. Circulation. 1998; 98 :1853-1859.
45 Galvani M, Ottani F , Ferrini D , et al. Prognostic influence of elevated values of cardiac troponin I in patients with unstableangina. Circulation. 1997; 95 :2053-2059.
46 Benamer H , Steg PG, Benessiano J , et al. Elevated cardiac troponin I predicts a high risk angiographic anatomy of the culprit lesion in unstable angina. Am Heart. 1999; 137 : 815-820.
47 Antman EM ,Petersen JL, Mahaffey KW, Hasselblad V, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: a systematic overview. JAMA. 2004; 292(l):89-96.
48 Luscher MS, Ravkilde J, Thygesen K. Clinical application of two novel rapid bedside tests for the detection of cardiac troponin T and creatine kinase-MB mass/myoglobin in whole blood in acute myocardial infarction.Cardiology. 1998; 89(3):222-228.
49 Lagerqvist B, Diderholm E, Lindahl B, Husted S, Kontny F, Stahle E, Swahn E, Venge P, Siegbahn A, Wallentin L. FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005; 91(8): 1047-1052.
50 Thielmann M, Massoudy P, Neuhauser M, Knipp S, Kamler M, Piotrowski J, Mann K, Jakob H Prognostic value of preoperative cardiac troponin I in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. Chest. 2005;128(5):3526-3536.
51 Jiang LQ, Zhao MZ, Hu DY Predictive value of positive troponin I in clinical prognosis of non-ST-segment elevation acute coronary syndrome. Zhonghua Nei Ke Za Zhi. 2005;44(5):350-352
52.Roe MT, Peterson ED, Pollack CV Jr, Newby LK, Li Y, Christenson RH, Peacock WF, Fesmire FM, Diercks D, Kirk JD, Smith SC Jr, Ohman EM, Gibler WB; CRUSADE InvestigatorsInfluence of timing of troponin elevation on clinical outcomes and use of evidence-based therapies for patients with non-ST-segment elevation acute coronary syndromes. Ann Emerg Med. 2005 Apr;45(4):355-62
53 Praveen K. Kanaparti, MBBS,MD, David L.Brown,MD.Relation between coronary atherosclerotic plaque burden and cardiac enzyme elevation following percutaneous coronary intervention.Am J Cardiol 2000;86:619-622
54 Galla JM, Mahaffey KW, Sapp SK, Alexander J-H, Roe MT, Ohman EM, Granger CB, Armstrong PW, Harrington RA, White HD, Simoons ML, Newby LK, Califf RM, Topol EJElevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acute coronary syndromes: results from 4 large clinical trials.Am Heart J. 2006 Jan;151(1):16-24)
55 Roe MT, Mahaffey KW, Kilaru R, Alexander JH, Akkerhuis KM, Simoons ML, Harrington RA, Tardiff BE, Granger CB, Ohman EM, Moliterno DJ, Lincoff AM, Armstrong PW, Van de Werf F, Califf RM, Topoi EJ.Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes. Eur Heart J. 2004 Feb;25(4):313-21
56 Benderly M, Graffe E, reicher-reiss H,et al. Fibinogen is predictor of mortility in coronary artery disease patients: the Bezafibrate Infarction Prevention (BIP) STUDY Group. Arterioscler Thromb Vasc Biol,1996, 16:351-356
57 Fredmun DS,Wiuiumson DF, Gunter EW, et al. Relation of serum uric acid to mortality and ischemic heart disease. The NHANESL Ep idemiologic follow up study[J]. Am J Epidem ol,1995, 141: 637-644.
58 Levine W, Dyer AR, Shekelle RB, et al. Serum uric acid andl 1.5-year mortality of middle2aged women [J]. J Clin Epidemiol, 1989, 42: 257-267.
59 陈文强，张运，张梅，等。心绞痛患者血清炎性因子和斑块超声特征的相关研究。中华医学杂志，2004，84(13)：1603—1605
60 Biasucci LM, Liuzz G, Grillo RL, et al. Elevated levels of C-reactive protein at disdischarge in patients with unstable angina predict recurrent instability. Circulation. 1999; 99:855-860.
61 Haverkate F, Simon G Thompson, Stephen D M PyKe, et al. Production of C-reative protein and risk of coronary events in stable and unstable angina. Lancet; 1997; 9050 (349): 462-466.
62 Liuzzo G,Biasucci LM ,Gallimore JR ,et al. The prognostic valve fC-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med.1994 ;331 (46) :417-424.
63 Manginas A, Bei E, Chaidaroglou A, Degiannis D, Koniavitou K, Voudris V, Pavlides G, Panagiotakos D, Cokkinos DV Peripheral levels of matrix metalloproteinase-9, interleukin-6, and C-reactive protein were elevated in patients with acute coronary syndromes: correlations with serum troponin I. Clin Cardiol. 2005; 28(4):182-186.
64 Morrow DA , de Lemos JA , Sabatine MS , et al. Evaluation of B -type natriuretic peptide for risk assessment in unstable angina/ non -ST - elevation myocardial infarction : B - type natriuretic peptide andprognosis in TACTICS - TIMI 18. Am Coll Cardiol. 2003; 41(10) :1852-1856.
65 Bazzino O, Fuselli JJ, Botto F, Perez De Werenaza D, Bahit C, Dadone J; PACS group of investigatorsRelative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes. Eur Heart. 2004; 25(10):859-866.
66 Blick KE. Department of Pathology, Oklahoma University Health Sciences Economics of Point-of-Cwere (POC).Testing for Cardiac MarkersPoint .2004; 83:355-359
67 Lindahl B, Lindback J, Jernberg T, Johnston N, Stridsberg M, Venge P, Wallentin LSerial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularisation during In Stability in Coronary artery disease (FRISC)-II substudy. Am Coll Cardiol. 2005;45(4):533-541.
68 Omland T, Persson A, Ng L, O'Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K.N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation. 2004; 17: 567-569.
69.Sabatine MS , Morrow DA , de Lemos JA , et al Multimarker approach to risk stratification in non - ST elevation acute coronary syndromes : simultaneous assessment of troponin I , C - reactive protein ,and B - type natriuretic peptide. Circulation., 2002;105 :1760-1765.
70 Mallat Z, Steg PG, Benessiano J, Tanguy ML, Fox KA, Collet JP, Dabbous OH, Henry P, Carruthers KF, Dauphin A, Arguelles CS, Masliah J, Hugel B, Montalescot G, Freyssinet JM, Asselain B, Tedgui A Circulating secretory Phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. Am Coll Cardiol. 2005; 46(7): 1249-1257.
71 Koukkunen H, K Pyorala and OHM. Low-risk patients with chest pain and with evidence of myocardial infarction may be safely disdischarged from emergency deparment. Eur Heart. 2004;25(4): 329-334.
72 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial InvestigatorsHealth-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). Am Coll Cardiol. 2005; 45(2):221-228..
73 Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarction myocardium early II trial substudy. Circulation. 2000; 102:2031-2037.
74 David R.Holmes,Jr,MD,Peter B, Berger, MD,Kirk N. Garratt, MD,et al.Application of the New York State PTCA mortality model in spatients undergoing stent implantation. Circulation.2000;102:517-522
75 Moussa I,Columbus CC Covaja N,et aLAngiographic and clinical outcome of patient with single left anterior descending artery disease undergoing elective Palmaze-Schate stent implantation.Cirlation.1997; 12: 96:1-694
76 葛均波．冠脉再狭窄病变的预测及介入治疗进展．海南医学．2002；4：23—25．
77 The Vestfold Heartcwere Study Group.Influence on lifestyle measures and five-year coronaryrisk by a comprehensive lifestyle interventionprogramme in patients with coronary heartdisease. European Journal of Cardiovascular Prevention and Rehabilitation. 2003; 6: 429-437
78 Chang WC, Midodzi WK, Westerhout CM, Boersma E, Cooper J, Barnathan ES, Simoons ML, Wallentin L, Ohman EM, Armstrong PW.Were international differences in the outcomes of acute coronary syndromes appwerent or real? A multilevel analysis. J Epidemiol Community Health. 2005;59(5):427-433.
79 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PWOutcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 338(25):1785-1792.
80 Williams DO, Braunwald E, Thompson B, Sharaf BL, Buller CE, Knatterud GL.Results of percutaneous transluminal coronary angioplasty in unstable angina and non-Q-wave myocardial infarction. Observations from the TIMI IIIB Trial. Circulation. 1996;94(11):2749-2755.
81 Piegias LS, fLATHERm, PogueJ. The Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry in patients with unstable angina. Am J Cardiol. 1999;84(5A):7M-12M.
82 Cannon CP, Weintraub WS, Demopoulos LA, Robertson DH, Gormley GJ, Braunwald E.Invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction following treatment with tirofiban: rationale and study design of the international TACTICS-TIMI 18 Trial. Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy. Thrombolysis In Myocardial Infarction. Am J Cardiol. 1998 Sep 15;82(6):731-736.
83 Bassand JP [Angioplasty in unstable chest angina. Angioplasty in unstable angina] Arch Mal Coeur Vaiss. 1999;92(11 Suppl): 1609-1615
84 Joerg Herrmann. Peri-procedural myocardial injury: 2005 updateEuropean Heart.2005; 26: 2493 -2519.
85 Scirica BM, Morrow DAAppropriate Invasive and Conservative Treatment Approaches for Patients with Non-ST-Elevation MI..Curr Treat Options Cardiovasc Med. 2006;8(1):13-21
86.Kandzari DE, Roe MT, Ohman EM, Milford-Beland S, Chen AY, Lytle BL, Cohen DJ, Smith SC, Harrington RA, Gibler WB, Peterson ED.Frequency, predictors, and outcomes of drug-eluting stent utilization in patients with high-risk non-ST-segment elevation acute coronary syndromes.. Am J Cardiol. 2005 ;96(6):750-755.
87 Moses JW, Mehran R, Nikolsky E, Lasala JM, Corey W, Albin G, Hirsch C, Leon MB, Russell ME, Ellis SG, Stone GW.Outcomes with the paclitaxel-eluting stent in patients with acute coronary syndromes: analysis from the TAXUS-IV trial. J Am Coll Cardiol. 2005;45(8): 1165-1171.
88 Labinaz M, Mathias J, Pieper K, Granger CB, Lincoff AM, Moliterno DJ, Van de Werf F, Simes J, White HD, Simoons ML, Califf RM, Topol EJ, Armstrong PW, Harrington RA .Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials. Eur Heart J. 2005;26(2): 128-136.
89 Regar E, et al.Angiographic finding of the multicenter randomized study with sirolimus-eluting velocity ball-expandable stent (RAVEL): sirolimus-eluting stent inhibit restenisis irrespective of the vessel size. Circulation, 2002, 106:1949-1956
90 Schofer J et al. Sirolimus-eluting stents for treatment patients with long atherosclerotic lesions in small coronary arteries : double-blind, randomized controlled trial (E-SIRIUS). Lancet. 2003; 362: 1093-1099
91 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation. 2003,108: 533-538.
92 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial InvestigatorsHealth-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). J Am Coll Cardiol. 2005;45(2):221-228..
93 Al-Mallah M, Dajani K, Hudson M, Iyengar H, Gutierrez N, Weaver WD, Khanal SLong-term outcomes based on time-to-angioplasty in patients admitted with non-ST-segment elevation acute coronary syndromes. J Invasive Cardiol. 2005;17(5):251-255.
94 Hoekstra JW, Roe MT, Peterson ED, Menon V, Mulgund J, Pollack CV, Miller C, Palabrica T, Harrington RA, Ohman EM, Gibler WB. Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: patient selection and associated treatment patterns.Acad Emerg Med..2005 ;12(5):431-438
95 Meine TJ, Roe MT, Chen AY, Patel MR, Washam JB, Ohman EM, Peacock WF, Pollack CV Jr, Gibler WB, Peterson ED; CRUSADE InvestigatorsAssoc iation of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart. 2005;149(6):1043-1049.
96 Mehta SR, yusuf S, Peters RJ, et al. Effect of pretreatment with clopidogrel and asplin followed by long term therapy in patients undergoing percutaneous coronary intervention: the PCICURE study. Lancet. 2001 ;358 : 527-533.
97 Antman EM, Cohen M,Bernink PJ,et.al. The TIMI risk score for unstable angina /non-ST elevation MI: a method for prognostication and therapeutic decision making JAMA. 2000;284 : 835-842.
98 Katsouras C, Michalis LK, Papamichael N, Adamides K, Naka KK, Nikas D, Goudevenos JA, Sideris DA.Enoxaparin versus tinzaparin in non-ST-segment elevation acute coronary syndromes: results of the enoxaparin versus tinzaparin (EVET) trial at 6 months.Am Heart . 2005;150(3):385-391.
99 Yusuf S, Zhao F , Mehta SR, et al . Effect of clopiddogreal in addition to aspirin to in patient with acute coronary artery syndromes without ST-segment elevation. N Engle J Med. 2001;345 :494-502.
100 oyner CD, Flather M. Statistical versus clinical significance of the CURE study in acute coronary artery syndromes. J Am Coll Cardiol. 2003.42(2):218-219.
101 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation. 2003;108: 533-546.
102 Norbert Frey, MD; Anne Dietz, MD; Volkhard Kurowski, MD; Evangelos Giannitsis, MD; Ralph To" lg, MD;Uwe Wiegand, MD; Gert Richardt, MD; Hugo A. Katus, MD Angiographic correlates of a positive troponin T test in patientswith unstable angina, Crit Cwere Med 2001. 6:1130-1136.
103 Lerman GL , Abumada AM, Posadas RC. The heart and diabetes mellitus. Arch Inst Cardiol Mex, 1990.60:79-84.
104 McKay RG "Ischemia-guided" versus "early invasive" strategies in the management of acute coronary syndrome/non-ST-segment elevation myocardial infarction: the interventionst,s perspective. J Am Coll Caardiol. 2003 ;41(4 suppl S) : 96S-102S
105 Aronow HD, Topol EJ, Roe MT, et al. Effects of lipid-lowering therapy on early mortality after acute coronary syndromes : Lancet. 2001; 357(92): 1063-1068.
106 Schwarte GG, Olsson AG, Ezekowitz MD,et al. Effects of atovastation on early recurrent ischemic events in acute coronary syndromes : The MIRACL study :a randomized controlled trial. JAMA. 2001; 285(13): 1711-1718.
107 Pasternak RC, Smith SC Jr, Bairey-Merz CN, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of stetins. J Am Coll Cardiol. 2002; 40(3) :567-572.
108 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial Investigators. Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). Am Coll Cardiol. 2005 ;45(2):221-228.
109 Zhao MZ, Hu DY, Jiang LQ, Wu Y, Zhu TG, Hao HJ, Zhang LJ, Huo Y, Wang MS The effect of early invasive strategy on early and late outcomes in high-risk non-ST-segment elevation acute coronary syndromes] Zhonghua Nei Ke Za Zhi. 2005;44(10):737-740.
2 Fox KA, Goodman SG, Anderson FA, et al. From guidelines to clinical practice: the impact of hospital and geographical characteristics on temporal trends in the management of acutecoronary syndromes. Eur Heart J, 2003; 24: 1414-1424.
3 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG; Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PW, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 18: 338(25): 1785-92
4 胡大一．无ST抬高的急性冠脉综合征更为常见．中华医药杂志．2002；4(1)：30
5 Furberg CD, Psaty BM,Meyer JV. Nifedip ine doserelated increase in mortality in patients with coronary heart disease. Circulation. 1995; 92:1326-1331.
6 谭慧琼，朱俊，梁岩．非ST段抬高的急性冠状动脉综合征二年随访．中华医学杂志．2005；85(3)：184-188
7 Yusuf S, FlatherM, Pogue J, et al. Variations between countries ininvasive cardiac procedures and outcomes in patients with suspectedunstabe angina or myocardial infarction without initial ST elevation. Lancet. 1998,;352: 507-514.
8 Collinson J, FlatherMD, Fox KA, et al. Clinical outcomes, risk stratification and practice patterns of unstable angina and mycardialinfarction without ST elevation: Prospective Registry of Acute Ischaemic Syndromes in the UK (PRA IS2UK). Eur Heart. 2000; 21: 1450-1457.
9 Stone PH, Thomp son B, Anderson HV, et al. Influence of race,sex, and age on management of unstable angina and non2Q2wavemyocardial infarction: The TIMI Ⅲ Registry. JAMA. 1996; 275:1104-1112.
10 Granger CB. Strategies of patient cwere in acute coronary syndromes:rationals for the Global Registry of Acute Coronary Events (GRACE)registry. Am J Cardiol. 2000; 86 Suppl: 4M-29M.
11 Patrono C,Bachmann F, Baigent C, et al. Expert consensus documenton the use of antip latelet agents: the task force on the use ofantip latelet agents in patients with atherosclerotic cardiovasculardisease of the European society of cardiology. Eur Heart. 2004;25: 166-181.
12 Braunwaid E, Antman EM, Beasley JW, et al. ACC/AHA Guideline update for the management of patientswith unstabe angina and non-STsegment elevation myocardial iarticle. Circulation. 2002; 106:1893-1990.
13 Hjalmarson F, Goldstein S, FagerbergB, et al. Effects of controlled release metop rolol on total mortality, hospitalization, and well beingin patients with heart failure. The metop rolol CR / XL randomizedinternational trial in congestive heart failure (MER IT2HF). JAMA. 2000; 238:1295-1302.
14 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin converting enzyme inhibitor, ramip ril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation Studylnvestigators. N Engl J Med. 2000; 342: 145-153.
15 Furberg CD, Psaty BM,Meyer JV. Nifedip ine doserelated increase in mortality in patients with coronary heart disease. Circulation. 1995; 92: 1326-1331.
16 梁岩，朱俊，谭慧琼等．OASIS登记试验中国地区协作组．中国地区非ST抬高急性冠脉综合征患者生存时间的影响因素分析．中华医学杂志．2005年，85(13)：873-877．
17 Boersma, PhD; Karen S. Pieper, MS; Ewout W. S[1]。Results From an International Trial of 9461 Patients teyerberg. Circulation. 2000;10(1):2557-2562.
18 Predictors of 90-day outcome in patients stabilized after acute coronary syndromes., Bhapkar MV, White HD, Topoi EJ, Dougherty FC, Harrington RA, Smith MC, Asarch LF, Califf RM; SYMPHONY and 2nd SYMPHONY Investigators. Eur Heart. 2003; 24(2): 172-181.
19 赵明中，胡大一，许玉韵，等1心电图变化及肌钙蛋白水平对非ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值 中华心血管病杂志．2003；31：568-572．
20 Ridker PM, Cook N1 Clinical usefulness of very high and very lowlevels of C-reactive protein across the full range offraminlgham riskscoresl. Circulation. 2004; 109: 1955-1959.
21 Cannon CP, McCabe CH, Stone PH, et allFor the TIMI Ⅲ Registry ECG Ancillary Study Investigators1 The electrocardiogram predicts One year outcome of patients with unstable angina and non-Q wave myocardial infarction: Results of the TIM I Ⅲ Registry ECG Ancillary Study. Am Coll Cardiol. 1997;30:1 33-140.
22 Mehta J L, Saldeen T G, Rand K. Interactive role of infection, inflammation and traditional risk factors in atherosclerosis and coronary artery disease. Am Coll Cardiol. 1998; 31(6): 1217-1222.
23 Kosar F, Varol E, Ayaz S, et al. Plasma leukocyte elastaseconcentration and coronary artery disease. Angiology. 1998; 49(3): 193-199.
24 Brown D W, Giles W H, Croft J B et al. White blood cellcount: an independent predictor of coronary heart disease mortalityamong a national cohort. Clin Epidemiol. 2001; 54(3): 316-319.
25 李建军．白细胞增多在急性心肌梗塞发生中的作用．天津医药．1991；7：444
26 Hajj,Ali R, ZwerebaW, Ezzeddine R, et al. Relation of the leukocyte count to recurrent cardiac events in stable patients after acutemyocardial infarction. Am J Cardiol. 2001; 88:1221-1224.
27 Barron HV, Hart SD, Radford MJ, et al. The association between white blood cell count and acute myocardial infarction mortality inpatients ≥ 65 years of age: findings from the cooperative cardiovascular project. Am Coll Cardiol. 2001; 38:1654 - 1661.
28 王雪青．纤维蛋白(原)在动脉粥样硬化发病中的作用及机．生理科学进展．1996；27(3)：245—248．
29 Ward DJ, Taylor. Guidelines for acute coronary syndrome without ST elevation.Lancet. 2002;35(9): 1340-1344.
30 Warmamethee G, Shaper AG, Macfarlane PW, et al. Risk factors for sudden death inmidde-aged British men. Circulation. 1995; 91: 1749-1753.
31 Newby LK, Bhapkar MV, White HD, et all Predictors of 90-dayoutcome in patients stabilized after acute coronary syndromes1. EurHeart. 2003; 24: 172-181
32 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PWOutcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 18(25): 1785-1792.
33 Yusuf S, FlatherM, Pogue J, et al. Variations between countries ininvasive cardiac p rocedures and outcomes in patients with suspectedunstabe angina or myocardial infarction without initial ST elevation. Lancet. 1998; 352: 507-514.
34 The FRISC II Investigators. Invasive compared with non-invasivetreatment in unstable coronary artery disease: FRISC II prospectiverandomised multicentre study. Lancet. 1999 ;354:708-715..
35 Gibson CM, Cannon CP.Influence of race on death and ischemic complications in patients with non-ST-elevation acute coronary syndromes despite modern, protocol-guided treatment. Circulation. 2005; 111(10):1217-24.
36 Sabatine MS, Morrow DA, Cannon CP, Murphy SA, Demopoulos LA, DiBattiste PM, McCabe CH, Braunwald E, Gibson CM.Relationship between baseline white blood cell count and degree of coronary artery disease and mortality in patients with acute coronary syndromes: a TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy- Thrombolysis in Myocardial Infarction 18 trial)substudy. Am Coll Cardiol. 2002; 40(10): 1761-1768.
37 Lagerqvist B, Diderholm E, Lindahl B, Husted S, Kontny F, Stahle E, Swahn E, Venge P, Siegbahn A, Wallentin LFRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005; 91(8):1047-1052.
38 Janzon M, Levin LA, Swahn E(?)nvasive treatment in unstable coronary artery disease promotes health-related quality of life: results from the FRISC II trial. Am Heart. 2004; 148(1):114-121
39 Januzzi JL Jr, Buros J, Cannon CP; Tactics TIMI 18 InvestigatorsPeripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial. Clin Cardiol. 2005; 28(5):238-242.
40 McCullough PA, Gibson CM, Dibattiste PM, Demopoulos LA, Murphy SA, Weintraub WS, Neumann FJ, Khanal S, Cannon CP; TACTICS-TIMI-18 Investigators.Timing of angiography and revascularization in acute coronary syndromes: an analysis of the TACTICS-TIMI-18 trial. J Interv Cardiol. 204 ; 17(2):81-86.
41 Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, Knight R, Pocock SJ.5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005; 366: 914-920.
42 赵明中，胡大一，姜立清，非ST段抬高急性冠状动脉综合征的危险因素分析及早期干预，中华心血管病杂志．2005；33(2)：153—155．
1 Pollack CV Jr, Roe MT, Peterson ED. 2002 Update to the ACC/AHAguidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med. 2003;41:355-369.
2 Koukkunen H, K Pyorala and OHM. Low-risk patients with chest pain and with evidence of myocardial infarction may be safely disdischarged from emergency deparment. Eur Heart. 2004; 25(4): 329-334.
3 Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol. 2004; 93(3): 288-293.
4 Sabatine MS, McCabe CH, Morrow DA, et al. Identification of patients at high risk for death and cardiac ischemic events after hospital disdischarge. Am Heart. 2002; 143(6): 966-970.
5 Koukkunen H, K Pyorala and O H M. Low-risk patients with chest pain and without evidence ofmyocardial infarction may be safely disdischarge from emergency department. Eur Heart. 2004; 25(4): 329-334.
6 Boersma, PhD; Kweren S. Pieper, MS; Ewout W. S[l]o Results From an International Trial of 9461 Patients teyerberg, PhD; Robert G. Wilcox, MD; Wei-Ching Chang, PhD; Kerry L. Lee, PhD; K. Martijn Akkerhuis, MD; Robert A. Harrington, MD; Jaap W. Deckers, MD; Paul W. Armstrong, MD; A. Michael Lincoff, MD; Robert M. Califf, MD; Eric J. Topol, MD; Maarten L. Simoons, MD; Circulation. 2000;101:2557-2562.
7 Predictors of 90-day outcome in patients stabilized after acute coronary syndromes., Bhapkar MV, White HD, Topol EJ, Dougherty FC, Harrington RA, Smith MC, Asarch LF, Califf RM; SYMPHONY and 2nd SYMPHONY Investigators. Eur Heart J. 2003; 24(2):172-181.
8 Hubbard BL, et al. Prospective evaluation of a clinical and exercise-test model for the prediction of left main coronary artery disease. Ann Interm MED 1993; 22 :118-123.
9 Eric Boersma, PhD; Kweren S. Pieper, MS; Ewout W. Steyerberg, PhD; Robert G. Wilcox, MD; Wei-Ching Chang, PhD; Kerry L. Lee, PhD; K. Martijn Akkerhuis, MD; Robert A. Harrington, MD; Jaap W. Deckers, MD; Paul W. Armstrong, MD; A. Michael Lincoff, MD; Robert M. Califf, MD; Eric J. Topol, MD; Maarten L. Simoons, MD; for the Investigators Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation. Circulation. 2000; 101:2557-2561.
10 Holmes DRJ, White HD, Pieper F, Ellis SG, Califf RM, Topol EJ. Effect of age on outcome with primary angioplasty versus thrombolysis . AM coll Cardiol 1999; 33:412-419.
11 White HD, Bash GI, Calliff RM, et al. Age and outcome with contemporary thrombolytic therapy: results from the GUSTO-1 trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial.. Circulation. 1996; 94:1826-1833.
12 Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet JP; GRACE Investigatorslmpact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE).. Am Heart. 2005; 149(1): 67-73.
13 Alexander KP, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Foody JM, Boden WE, Smith SC Jr, Gibler WB, Ohman EM, in cardiovascular cwere for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative.Peterson ED; CRUSADE Investigators. Am Coll Cardiol. 2005; 46(8): 1479-87.
14 Boersma, PhD; Kweren S. Pieper, MS; Ewout W. Steyerberg, PhD; Robert G. Wilcox, MD; Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation. Circulation. 2000; 101:2557-2564.
15 Timoteo AT, Ferreira J, Aguiar C, Almeida Mde S, Ribeiro MA, Cavaco DM, Trabulo M, Seabra-Gomes R Revascularization and prognosis in female patients with non-ST-segment elevation acute coronary syndromes. Rev Port Cardiol. 2003; 22(3):367-374.
16 Bruce D. Klugherz,MD,Nicolas F.Meneveau, MD, Daniel M.Kolansky,MD,et al. Predictors of clinical outcome following percutaneous intervention for in-stent restenosis.AM J Cardiol. 2000; 85:1427-1431.
17 Theodore A.Bass,MD.Post-PCI Cardiac events? The answer is the lumen ,or is it in the wall?.cCatherterization and cardiovascular interventions. Arch Inst Cardiol Mex. 2002; 55:338-339.
18 Semenkovich CF, Heinfche JW. Perspective in diabetes: the mystery of diabetes and atherosclerosis. Diabetes ,. 1997; 46: 327-334.
19 代政学，贾国良，李兰荪，等．伴有非胰岛素依赖型糖尿病冠心病患者冠状动脉病变和临床特征分析．第四军医大学学报．1999；20：2．
20 Lerman GL, Abumada AM, Posadas RC. The heart and diabetes mellitus. Arch Inst Cardiol Mex. 1990; 60:79-84.
21 Peter Mazeika, MD,Neeraj Prasad,MD,Sanh Bui,BSc, peter H.Seide lin, MD, FACC.Predictors of angiographic restenosis after coronary intervention in patient with diabetes mellitus.AM Heart. 2003; 145:1013-1021.
22 Brogan GX Jr, Peterson ED, Mulgund J, Bhatt DL, Ohman EM, Gibler WB, Pollack CV Jr, Farkouh ME, Roe MT.Treatment Disparities in the Cwere of Patients With and Without Diabetes Presenting With Non-ST-Segment Elevation Acute Coronary Syndromes.Diabetes Cwere. 2006; 29(1):9-14.
23 Willerson JT. Editor, scommentary: center of excellence. Circulation. 2003; 107:1471-2
24 Chochola M, Linhart A. Epidemiology of peripheral arterial occlusive disease. Cas Lek Cesk. 2006; 145(5):368-370.
25 Celven AH, Kesster AD, Hooi JD, Knottnerus JA Cardiovascular outcome stratification using the ankle-brachial pressure index. Eur J Gen Pract. 2005; 11(3-4):107-112.
26 Januzzi JL Jr, Buros J, Cannon CP; Tactics TIMI 18 Investigators. Peripheral arterial disease, acute coronary syndromes, and early invasive management: the TACTICS TIMI 18 trial. Clin Cardiol. 2005; 28(5):238-242.
27 Holmvang L, Luscher MS, Clemmensen P, et al. Very earlyrisk stratification using combined ECG and biochemical assess-ment in patients with unstable coronary artery disease. Circula-tion. 1998; 98: 2004-2009.
28 Zhao MZ, Hu DY, Zhang FC, Wu Y, Yan MY, Wang SW, Mao JM, Yang M, Jiang LQ.The changes of electrocardiogram and impact of early invasive strategy in patients with acute coronary syndromes without ST-segment elevation] Zhonghua Yi Xue Za Zhi. 2005; 85(13):879-882.
29 Savonitto S, Cohen MG, Politi A, Hudson MP, Kong DF, Huang Y, Pieper KS, Mauri F, Wagner GS, Califf RM, Topol EJ, Granger CBExtent of ST-segment depression and cardiac events in non-ST-segment elevation acute coronary syndromes. Eur Heart. 2005; 26(20):2106-2113.
30 Kosuge M, Kimura K, Ishikawa T, Ebina T, Shimizu T, Hibi K, Toda N, Tahara Y, Tsukahara K, Kanna M, Okuda J, Nozawa N, Ozaki H, Yano H, Umemura SPredictors of left main or three-vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation. Am J Cardiol. 2005; 95(11):1366-1369.
31 Antman EM ,Petersen JL, Mahaffey KW, Hasselblad V, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: a systematic overview.. 2004; 292(1):89-96.
32 Sabatine MS, McCabe CH, Morrow DA, et al. Identification of patients at high risk for death and cardiac ischemic events after hospital disdischarge. Am Heart. 2002; 143(6): 966-970
33 Miwako Shihara,MD, Hiroyuki Tsutsui, MD, Miyuki Tsuchiashi,MS. In-hispital and one-year outcomes for pations undergoing percutaneous coronary intervention for acute myocardial infarction. AM J Cardiol. 2002; 90:932-936
34 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation, 2003;108: 533-535.
35 Collet JP, Montalescot G, Agnelli G, Van de Werf F, Gurfinkel EP, Lopez-Sendon J, Laufenberg CV, Klutman M, Gowda N, Gulba D; GRAC E InvestigatorsNon-ST-segment elevation acute coronary syndrome in patients with renal dysfunction: benefit of low-molecular-weight heparin alone or with glycoprotein IIb/IIIa inhibitors on outcomes. The Global Registry of Acute Coronary Events.. Eur Heart. 2005; 26(21):2285-2293.
36 Santopinto JJ, Fox KA, Goldberg RJ, Budaj A, Pinero G, Avezum A, Gulba D, Esteban J, Gore JM, Johnson J, Gurfinkel EP; GRACE InvestigatorsCreatinine clearance and adverse hospital outcomes in patients with acute coronary syndromes: findings from the global registry of acute coronary events (GRACE).. Heart. 2003; 89(9):1003-1008.
37 Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, Granger CB, Ohman EM, Holmes DR Jr; GUSTO-IIb, GUSTO-III, PURSUIT. Global Use of Strategies to Open Occluded Coronary Arteries. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy; PARAGON-A Investigators. Platelet Ilb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization NetworkPrognostic implications of abnormalities in renal function in patients with acute coronary syndromes. J Am Coll Cardiol. 2004; 23:234-245.
38 de Lemos JA, Morrow DA, Gibson CM, Murphy SA, Sabatine MS, Rifai N, McCabe CH, Antman EM, Cannon CP, Braunwald EThe prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes. Results from the TEMI 11B and TACTICS-TIMI 18 studies. Am Coll Cardiol. 2002; 40(2):238-44..
39 Furman MI, Gore JM, Anderson FA, Budaj A, Goodman SG, Avezum A, Lopez-Sendon J, Klein W, Mukherjee D, Eagle KA, Dabbous OH, Goldberg RJ; GRACE Investigators.Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2004;147(l):42-48.
40 Norbert Frey, MD; Anne Dietz, MD; Volkhard Kurowski, MD; Evangelos Giannitsis, MD; Ralph To" lg, MD;Uwe Wiegand, MD; Gert Richardt, MD; Hugo A. Katus, MD Angiographic correlates of a positive troponin T test in patients with unstable angina. Crit Cwere Med. 2001; 29:.1130-1136.
41 Shmuel Fuch, MD, luis Gruberg, MD,Sandeep Singh,MD, et al.Prognostic value of cardiac teoponin I re-elevation following percutaneous coronary intervention in high-risk patient with actue coronary syndromes. AM J Cardiol 2001;88:129-133.
42.Antman EM, Janasijevic MJ , Thompson B , et al. Cardic-specific troponin I levels to predict the risk of mortality in patients withacute coronary syndromes. N Engl J Med. 1996; 335 :1342-1349.
43 Ottani F , Galvani M, Nicolini FA , et al. Elevated cardiac troponin levels predict the risk of adverse outcome in patients withacute coronary syndromes. Am Heart. 2000; 140 :917-927.
44 Newby LK, Christenson RH , Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in paients with acute coronary syndromes. The GUSTO211a Investi-gators. Circulation. 1998; 98 :1853-1859.
45 Galvani M, Ottani F , Ferrini D , et al. Prognostic influence of elevated values of cardiac troponin I in patients with unstableangina. Circulation. 1997; 95 :2053-2059.
46 Benamer H , Steg PG, Benessiano J , et al. Elevated cardiac troponin I predicts a high risk angiographic anatomy of the culprit lesion in unstable angina. Am Heart. 1999; 137 : 815-820.
47 Antman EM ,Petersen JL, Mahaffey KW, Hasselblad V, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-Segment elevation acute coronary syndromes: a systematic overview. JAMA. 2004; 292(l):89-96.
48 Luscher MS, Ravkilde J, Thygesen K. Clinical application of two novel rapid bedside tests for the detection of cardiac troponin T and creatine kinase-MB mass/myoglobin in whole blood in acute myocardial infarction.Cardiology. 1998; 89(3):222-228.
49 Lagerqvist B, Diderholm E, Lindahl B, Husted S, Kontny F, Stahle E, Swahn E, Venge P, Siegbahn A, Wallentin L. FRISC score for selection of patients for an early invasive treatment strategy in unstable coronary artery disease. Heart. 2005; 91(8): 1047-1052.
50 Thielmann M, Massoudy P, Neuhauser M, Knipp S, Kamler M, Piotrowski J, Mann K, Jakob H Prognostic value of preoperative cardiac troponin I in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. Chest. 2005;128(5):3526-3536.
51 Jiang LQ, Zhao MZ, Hu DY Predictive value of positive troponin I in clinical prognosis of non-ST-segment elevation acute coronary syndrome. Zhonghua Nei Ke Za Zhi. 2005;44(5):350-352
52.Roe MT, Peterson ED, Pollack CV Jr, Newby LK, Li Y, Christenson RH, Peacock WF, Fesmire FM, Diercks D, Kirk JD, Smith SC Jr, Ohman EM, Gibler WB; CRUSADE InvestigatorsInfluence of timing of troponin elevation on clinical outcomes and use of evidence-based therapies for patients with non-ST-segment elevation acute coronary syndromes. Ann Emerg Med. 2005 Apr;45(4):355-62
53 Praveen K. Kanaparti, MBBS,MD, David L.Brown,MD.Relation between coronary atherosclerotic plaque burden and cardiac enzyme elevation following percutaneous coronary intervention.Am J Cardiol 2000;86:619-622
54 Galla JM, Mahaffey KW, Sapp SK, Alexander J-H, Roe MT, Ohman EM, Granger CB, Armstrong PW, Harrington RA, White HD, Simoons ML, Newby LK, Califf RM, Topol EJElevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with acute coronary syndromes: results from 4 large clinical trials.Am Heart J. 2006 Jan;151(1):16-24)
55 Roe MT, Mahaffey KW, Kilaru R, Alexander JH, Akkerhuis KM, Simoons ML, Harrington RA, Tardiff BE, Granger CB, Ohman EM, Moliterno DJ, Lincoff AM, Armstrong PW, Van de Werf F, Califf RM, Topoi EJ.Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes. Eur Heart J. 2004 Feb;25(4):313-21
56 Benderly M, Graffe E, reicher-reiss H,et al. Fibinogen is predictor of mortility in coronary artery disease patients: the Bezafibrate Infarction Prevention (BIP) STUDY Group. Arterioscler Thromb Vasc Biol,1996, 16:351-356
57 Fredmun DS,Wiuiumson DF, Gunter EW, et al. Relation of serum uric acid to mortality and ischemic heart disease. The NHANESL Ep idemiologic follow up study[J]. Am J Epidem ol,1995, 141: 637-644.
58 Levine W, Dyer AR, Shekelle RB, et al. Serum uric acid andl 1.5-year mortality of middle2aged women [J]. J Clin Epidemiol, 1989, 42: 257-267.
59 陈文强，张运，张梅，等。心绞痛患者血清炎性因子和斑块超声特征的相关研究。中华医学杂志，2004，84(13)：1603—1605
60 Biasucci LM, Liuzz G, Grillo RL, et al. Elevated levels of C-reactive protein at disdischarge in patients with unstable angina predict recurrent instability. Circulation. 1999; 99:855-860.
61 Haverkate F, Simon G Thompson, Stephen D M PyKe, et al. Production of C-reative protein and risk of coronary events in stable and unstable angina. Lancet; 1997; 9050 (349): 462-466.
62 Liuzzo G,Biasucci LM ,Gallimore JR ,et al. The prognostic valve fC-reactive protein and serum amyloid A protein in severe unstable angina. N Engl J Med.1994 ;331 (46) :417-424.
63 Manginas A, Bei E, Chaidaroglou A, Degiannis D, Koniavitou K, Voudris V, Pavlides G, Panagiotakos D, Cokkinos DV Peripheral levels of matrix metalloproteinase-9, interleukin-6, and C-reactive protein were elevated in patients with acute coronary syndromes: correlations with serum troponin I. Clin Cardiol. 2005; 28(4):182-186.
64 Morrow DA , de Lemos JA , Sabatine MS , et al. Evaluation of B -type natriuretic peptide for risk assessment in unstable angina/ non -ST - elevation myocardial infarction : B - type natriuretic peptide andprognosis in TACTICS - TIMI 18. Am Coll Cardiol. 2003; 41(10) :1852-1856.
65 Bazzino O, Fuselli JJ, Botto F, Perez De Werenaza D, Bahit C, Dadone J; PACS group of investigatorsRelative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes. Eur Heart. 2004; 25(10):859-866.
66 Blick KE. Department of Pathology, Oklahoma University Health Sciences Economics of Point-of-Cwere (POC).Testing for Cardiac MarkersPoint .2004; 83:355-359
67 Lindahl B, Lindback J, Jernberg T, Johnston N, Stridsberg M, Venge P, Wallentin LSerial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularisation during In Stability in Coronary artery disease (FRISC)-II substudy. Am Coll Cardiol. 2005;45(4):533-541.
68 Omland T, Persson A, Ng L, O'Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K.N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation. 2004; 17: 567-569.
69.Sabatine MS , Morrow DA , de Lemos JA , et al Multimarker approach to risk stratification in non - ST elevation acute coronary syndromes : simultaneous assessment of troponin I , C - reactive protein ,and B - type natriuretic peptide. Circulation., 2002;105 :1760-1765.
70 Mallat Z, Steg PG, Benessiano J, Tanguy ML, Fox KA, Collet JP, Dabbous OH, Henry P, Carruthers KF, Dauphin A, Arguelles CS, Masliah J, Hugel B, Montalescot G, Freyssinet JM, Asselain B, Tedgui A Circulating secretory Phospholipase A2 activity predicts recurrent events in patients with severe acute coronary syndromes. Am Coll Cardiol. 2005; 46(7): 1249-1257.
71 Koukkunen H, K Pyorala and OHM. Low-risk patients with chest pain and with evidence of myocardial infarction may be safely disdischarged from emergency deparment. Eur Heart. 2004;25(4): 329-334.
72 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial InvestigatorsHealth-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). Am Coll Cardiol. 2005; 45(2):221-228..
73 Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarction myocardium early II trial substudy. Circulation. 2000; 102:2031-2037.
74 David R.Holmes,Jr,MD,Peter B, Berger, MD,Kirk N. Garratt, MD,et al.Application of the New York State PTCA mortality model in spatients undergoing stent implantation. Circulation.2000;102:517-522
75 Moussa I,Columbus CC Covaja N,et aLAngiographic and clinical outcome of patient with single left anterior descending artery disease undergoing elective Palmaze-Schate stent implantation.Cirlation.1997; 12: 96:1-694
76 葛均波．冠脉再狭窄病变的预测及介入治疗进展．海南医学．2002；4：23—25．
77 The Vestfold Heartcwere Study Group.Influence on lifestyle measures and five-year coronaryrisk by a comprehensive lifestyle interventionprogramme in patients with coronary heartdisease. European Journal of Cardiovascular Prevention and Rehabilitation. 2003; 6: 429-437
78 Chang WC, Midodzi WK, Westerhout CM, Boersma E, Cooper J, Barnathan ES, Simoons ML, Wallentin L, Ohman EM, Armstrong PW.Were international differences in the outcomes of acute coronary syndromes appwerent or real? A multilevel analysis. J Epidemiol Community Health. 2005;59(5):427-433.
79 Boden WE, O'Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PWOutcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compwered with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. N Engl J Med. 1998; 338(25):1785-1792.
80 Williams DO, Braunwald E, Thompson B, Sharaf BL, Buller CE, Knatterud GL.Results of percutaneous transluminal coronary angioplasty in unstable angina and non-Q-wave myocardial infarction. Observations from the TIMI IIIB Trial. Circulation. 1996;94(11):2749-2755.
81 Piegias LS, fLATHERm, PogueJ. The Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry in patients with unstable angina. Am J Cardiol. 1999;84(5A):7M-12M.
82 Cannon CP, Weintraub WS, Demopoulos LA, Robertson DH, Gormley GJ, Braunwald E.Invasive versus conservative strategies in unstable angina and non-Q-wave myocardial infarction following treatment with tirofiban: rationale and study design of the international TACTICS-TIMI 18 Trial. Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy. Thrombolysis In Myocardial Infarction. Am J Cardiol. 1998 Sep 15;82(6):731-736.
83 Bassand JP [Angioplasty in unstable chest angina. Angioplasty in unstable angina] Arch Mal Coeur Vaiss. 1999;92(11 Suppl): 1609-1615
84 Joerg Herrmann. Peri-procedural myocardial injury: 2005 updateEuropean Heart.2005; 26: 2493 -2519.
85 Scirica BM, Morrow DAAppropriate Invasive and Conservative Treatment Approaches for Patients with Non-ST-Elevation MI..Curr Treat Options Cardiovasc Med. 2006;8(1):13-21
86.Kandzari DE, Roe MT, Ohman EM, Milford-Beland S, Chen AY, Lytle BL, Cohen DJ, Smith SC, Harrington RA, Gibler WB, Peterson ED.Frequency, predictors, and outcomes of drug-eluting stent utilization in patients with high-risk non-ST-segment elevation acute coronary syndromes.. Am J Cardiol. 2005 ;96(6):750-755.
87 Moses JW, Mehran R, Nikolsky E, Lasala JM, Corey W, Albin G, Hirsch C, Leon MB, Russell ME, Ellis SG, Stone GW.Outcomes with the paclitaxel-eluting stent in patients with acute coronary syndromes: analysis from the TAXUS-IV trial. J Am Coll Cardiol. 2005;45(8): 1165-1171.
88 Labinaz M, Mathias J, Pieper K, Granger CB, Lincoff AM, Moliterno DJ, Van de Werf F, Simes J, White HD, Simoons ML, Califf RM, Topol EJ, Armstrong PW, Harrington RA .Outcomes of patients with acute coronary syndromes and prior percutaneous coronary intervention: a pooled analysis of three randomized clinical trials. Eur Heart J. 2005;26(2): 128-136.
89 Regar E, et al.Angiographic finding of the multicenter randomized study with sirolimus-eluting velocity ball-expandable stent (RAVEL): sirolimus-eluting stent inhibit restenisis irrespective of the vessel size. Circulation, 2002, 106:1949-1956
90 Schofer J et al. Sirolimus-eluting stents for treatment patients with long atherosclerotic lesions in small coronary arteries : double-blind, randomized controlled trial (E-SIRIUS). Lancet. 2003; 362: 1093-1099
91 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation. 2003,108: 533-538.
92 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial InvestigatorsHealth-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). J Am Coll Cardiol. 2005;45(2):221-228..
93 Al-Mallah M, Dajani K, Hudson M, Iyengar H, Gutierrez N, Weaver WD, Khanal SLong-term outcomes based on time-to-angioplasty in patients admitted with non-ST-segment elevation acute coronary syndromes. J Invasive Cardiol. 2005;17(5):251-255.
94 Hoekstra JW, Roe MT, Peterson ED, Menon V, Mulgund J, Pollack CV, Miller C, Palabrica T, Harrington RA, Ohman EM, Gibler WB. Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: patient selection and associated treatment patterns.Acad Emerg Med..2005 ;12(5):431-438
95 Meine TJ, Roe MT, Chen AY, Patel MR, Washam JB, Ohman EM, Peacock WF, Pollack CV Jr, Gibler WB, Peterson ED; CRUSADE InvestigatorsAssoc iation of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart. 2005;149(6):1043-1049.
96 Mehta SR, yusuf S, Peters RJ, et al. Effect of pretreatment with clopidogrel and asplin followed by long term therapy in patients undergoing percutaneous coronary intervention: the PCICURE study. Lancet. 2001 ;358 : 527-533.
97 Antman EM, Cohen M,Bernink PJ,et.al. The TIMI risk score for unstable angina /non-ST elevation MI: a method for prognostication and therapeutic decision making JAMA. 2000;284 : 835-842.
98 Katsouras C, Michalis LK, Papamichael N, Adamides K, Naka KK, Nikas D, Goudevenos JA, Sideris DA.Enoxaparin versus tinzaparin in non-ST-segment elevation acute coronary syndromes: results of the enoxaparin versus tinzaparin (EVET) trial at 6 months.Am Heart . 2005;150(3):385-391.
99 Yusuf S, Zhao F , Mehta SR, et al . Effect of clopiddogreal in addition to aspirin to in patient with acute coronary artery syndromes without ST-segment elevation. N Engle J Med. 2001;345 :494-502.
100 oyner CD, Flather M. Statistical versus clinical significance of the CURE study in acute coronary artery syndromes. J Am Coll Cardiol. 2003.42(2):218-219.
101 Stone GW, et al. The pivotal U.S. study of the slow-rate release polymer-based paclitaxel-eluting TAXUS IVstents in patient with de novo coronary lesion: 1-year clinical results of the TAXUS IV trial. Circulation. 2003;108: 533-546.
102 Norbert Frey, MD; Anne Dietz, MD; Volkhard Kurowski, MD; Evangelos Giannitsis, MD; Ralph To" lg, MD;Uwe Wiegand, MD; Gert Richardt, MD; Hugo A. Katus, MD Angiographic correlates of a positive troponin T test in patientswith unstable angina, Crit Cwere Med 2001. 6:1130-1136.
103 Lerman GL , Abumada AM, Posadas RC. The heart and diabetes mellitus. Arch Inst Cardiol Mex, 1990.60:79-84.
104 McKay RG "Ischemia-guided" versus "early invasive" strategies in the management of acute coronary syndrome/non-ST-segment elevation myocardial infarction: the interventionst,s perspective. J Am Coll Caardiol. 2003 ;41(4 suppl S) : 96S-102S
105 Aronow HD, Topol EJ, Roe MT, et al. Effects of lipid-lowering therapy on early mortality after acute coronary syndromes : Lancet. 2001; 357(92): 1063-1068.
106 Schwarte GG, Olsson AG, Ezekowitz MD,et al. Effects of atovastation on early recurrent ischemic events in acute coronary syndromes : The MIRACL study :a randomized controlled trial. JAMA. 2001; 285(13): 1711-1718.
107 Pasternak RC, Smith SC Jr, Bairey-Merz CN, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of stetins. J Am Coll Cardiol. 2002; 40(3) :567-572.
108 Kim J, Henderson RA, Pocock SJ, Clayton T, Sculpher MJ, Fox KA; RITA-3 Trial Investigators. Health-related quality of life after interventional or conservative strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction: one-year results of the third Randomized Intervention Trial of unstable Angina (RITA-3). Am Coll Cardiol. 2005 ;45(2):221-228.
109 Zhao MZ, Hu DY, Jiang LQ, Wu Y, Zhu TG, Hao HJ, Zhang LJ, Huo Y, Wang MS The effect of early invasive strategy on early and late outcomes in high-risk non-ST-segment elevation acute coronary syndromes] Zhonghua Nei Ke Za Zhi. 2005;44(10):737-740.