早期侵襲的対非侵襲的治療における非ST上昇性急性冠動脈症候群 (FRISC-II):将来性,ランダム化,多センター試験の15年間の追跡調査
Lars Wallentin1, Lars Lindhagen2, Elisabet Ärnström2
1Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Lancet (London, England)
|September 3, 2016
まとめ
早期侵襲的戦略は,ST上昇のない急性冠動脈症候群の患者で15年以上にわたって死亡率または心筋梗塞を大幅に減少させた. このアプローチは特に非喫煙者や バイオマーカー値が上昇した人には有益で 心血管疾患の発生を遅らせます
科学分野:
- 心臓病科
- 臨床試験
- 急性冠動脈症候群
背景:
- FRISC- II試験では,ST上昇のない急性冠動脈症候群 (NSTE- ACS) の早期侵襲的治療の効果が確認されました.
- この戦略が患者の残りの人生に与える長期的効果は以前は知られていなかった.
研究 の 目的:
- NSTE- ACS患者におけるすべての心血管疾患に対する早期侵襲的対非侵襲的戦略の長期的な (15年) 効果を評価する.
- 治療の有効性に関する残りの生涯の見通しを提供するためです.
主な方法:
- 2457人のNSTE- ACS患者を含む前向きなランダム化多センター試験.
- 早期侵襲的戦略 (7日以内の再血管化) と非侵襲的戦略の比較
- 長期フォローアップデータは,国家保健記録とリンクされ,治療の意図によってアウトカムが分析されました.
主要な成果:
- 侵襲的戦略により,死亡や次の心筋梗塞を平均549日 (p=0. 0020) 延期して15年経過しました.
- この延期は,非喫煙者,トロポニンT値が上昇した患者,および高成長分化因子-15値を有する患者において,著しく増加した.
- 侵襲的戦略はまた,心不全の再入院を平均1,128日 (p<0,0001) 延期した.
結論:
- NSTE- ACS患者において,早期の侵襲的な戦略は,重大な心血管疾患の発生と再入院を遅らせることで,長期的に有意義な効果をもたらします.
- NSTE- ACS患者のほとんどは早期侵襲的な治療法を好みます.
- サブグループ分析は,このアプローチから最も恩恵を受ける特定の患者集団を強調しています.
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