Impact Of Treatment Strategy On Recent And Long-term Outcomes For Patients With Acute Coronary Syndromes

ObjectiveWe analyzed the data of1212patients with acute coronary syndromes(ACS) who were treated in Shenyang military district general hospital fromDecember2004to February2006, and retrospectively evaluate the currentstatus of ACS treatment and the impact of different treatment strategies inperioperative period on short-term (30d)and long-term (one year)outcomes forpatients with ACS undergoing coronary stenting.MethodsThis study was a post hoc analysis of a single centre, randomized,controlled, open label trial. Between December2004and February2006, a totalof1212consecutive patients with ACS and underwent coronary stenting inShenyang military district general hospital were enrolled. All of the patientssigned consent form and were vetted by ethics committee of Shenyang militarydistrict general hospital. We summarized the perioperative drug therapy，dividedthem into two groups according whether using cilostazol, Beta blockers,angiotensin converting enzyme inhibitors, statins, calcium channel blockers anddrug-eluting stents and used a chi-square test and Logistic regression analysismethods explore the relationship of the perioperative therapy in patients withACS and the incidence of major adverse cardiac or cerebral event within30days and one year after the PCI.Evaluate the impact of treatment situation and different treatment strategies in perioperative period on short-term andlong-term outcomes for patients with ACS undergoing coronary stenting.ResultsBy analysis perioperative therapy on1212cases of ACS we can see thatthe baseline in groups by cilostazol, heparin, calcium channel blockers wassimilar while there were nuances of previous medical history in groups of ACEI,Beta blockers, statins and DES. However, the incidence of MACCE in onemonth is related with Whether using drugs of statins, Beta blockers, ACEI, tripleantiplatelet therapy(Aspirin, clopidogrel, cilostazol) and DES (P<0.05).Furthermore, Logistic regression analysis showed that the incidence of majoradverse cardiac or cerebral event were independent negative correlated withDES（OR=0.098，95%CI：0.021-0.460，P=0.003）, triple antiplatelet therapy（OR=0.277，95%CI：0.084-0.908，P=0.034）,ACEI（OR=0.255，95%CI：0.081-0.798，P=0.019）,statins（OR=0.148，95%CI：0.051-0.434，P＜0.001）and Beta blockers（OR=0.287，95%CI：0.097-0.846，P=0.024）but irrelevantwith heparin(OR=1.875，95%CI：0.512-6.868,P=0.343) and calcium channelblockers (OR＜0.001，95%CI：＜0.001-999.999,P=0.997).Compared with theresults of30days, DES and triple antiplatelet therapy also take effective roles inreduce the incidence of MACCE. Logistic regression analysis showed thatDES(OR=0.548，95%CI：0.380-0.791， P=0.001), triple antiplatelettherapy(OR=0.647，95%CI：0.456-0.918，P=0.015). Statins（OR=0.254，95%CI：0.125-0.516，P＜0.001）and DES（OR=0.213，95%CI：0.090-0.507，P＜0.001）is independent predictors of reduce mortality in one-year.ConclusionsIn accordance with the guidelines application statin, beta blockers, ACEI,may reduce the incidence of MACCE within one month in ACS patients. And forpatients at high risk, DES and triple antiplatelet therapy reduces the risk ofMACCE not only in one month but also in one year. statin and DES can reducemortality in one year after PCI.