| The acute coronary syndrome is a series of coronary disease clinical pathology physiology condition including unstable angina, acute ST segment elevation myocardial infarction, acute non-ST segment elevation myocardial infarction, the cardiac arrest and the sudden death. In the last few years, research of clinical strategy about the acute coronary syndrome already became a hot spot in coronary disease domain.The acute coronary syndrome is emergency case clinically, sometimes it may endanger the patient's life, if we can diagnose and give positive and correct processing promptly, we may improve patient's clinical prognosis greatly. However, we still debate unceasingly about the strategy of acute coronary syndrome. From the earliest TIMI B trial in 1994 to VANQWISH trial in 1998, we found that the early intervention strategy cannot reduce the risk of death and myocardial infarction, instead the early intervention strategy possibly increases the risk of die or the non-lethality cardiac arrest, therefore we advocates the medicine conservative treatment. But along with the progress of technology and medicine, in positive pharmacological treatment foundation, including anticoagulant drug, as well as new the medicineⅡb/Ⅲa acceptor antagonist compound on clinical the application, the indication of intervention treatment relaxes gradually, more and more clinical trials such as FRISCⅡ, TACTICS-TIMI 18 and RITA-3 indicate that intervention is a better strategy.But there comes a new problem : when to perform the intervention, To investigate the differences of clinical effects,safety and follow- up results between early and delayed percutaneous coronary intervention in acute non-ST segment elevation myocardial infarction. We selected 58 NSTEMI patients During March 2007 to September 2007,31 patients were randomized to early interventional group and 27 patients were randomized to delayed interventional group. Record the basic clinical feature, such as gender, age, history, clinical treatment, outcomes of PCI and so on. Record the therapeutic process and adverse coronary events during hospitalization and 30-day follow-up and 180-day follow-up result.We found that all 56 patients performed the PCI successfully, baseline angiography and clinical characteristics of the two groups were comparable, procedural success rates and complete revascularization rates were also similar. During hospitalization, no patients died, major adverse cardiac events (death, new- onset myocardial infarction or revascularization) were 4.7% vs. 6.5%, p= 0.654) in early and delayed group. Patients in early group has a shorter hospital stay and CCU stay than delayed group [ (8.95±3.64 d) vs. (15.12±4.28 d), p=0.036][ (16.71±6.25 h) vs. (50.06±2.12 h), p=0.001]。Adverse coronary events in 30-day follow-up and 180-day follow-up rates were similar. 30 patients in all 58 patients used the Tirofiban and complications during PCI process is less than patients who didn't use Tirofiban ( 0% vs. 14.3%, p=0.045) . In early group, there were 17 patients used the drug– Tirofiban, and these patients had a low ratio of the complications during PCI process.Early intervention strategy of acute non-ST segment elevation myocardial infarction was safety and efficacy as well as the delayed intervention strategy; they have the same ratio of percutaneous coronary intervention success and adverse cardiac events. But early intervention could improve the clinical symptom remarkably, and make a shorter hospital stay and CCU stay than the delayed intervention. The use of Tirofiban can reduce the rate of complications during percutaneous coronary intervention in early group. During 30-day follow-up and 180-day follow-up, the early group and the delayed group had the same ratio of adverse cardiac events, but patients in the early group had a better improvement of the heart function and ECG changes. Therefore from the angle of security and potency ratio, it is a more appropriate time selection that performs the intervention within 24 hour of the arrest of non-ST segment elevation myocardial infarction.
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