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このページは機械翻訳されています。他のページは英語で表示される場合があります。View in English
  1. ホーム
  3. 研究分野
  5. 生物医学と臨床科学
  7. 心血管医学と血液学
  9. 心臓病 (心血管疾患を含む)
  11. 心不全または左心室機能障害の既往歴のある患者の安定した心不全の初期侵襲的対保守的管理:ischemia試験からの洞察

心不全または左心室機能障害の既往歴のある患者の安定した心不全の初期侵襲的対保守的管理:ISCHEMIA試験からの洞察

Renato D Lopes1, Karen P Alexander2, Susanna R Stevens2

  • 1Duke University Medical Center, Durham, NC (R.D.L., M.K.).

Circulation
|September 1, 2020

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PubMed で要約を見る

まとめ
この要約は機械生成です。

安定した缺血性心臓病と心不全 (HF) または左心室機能障害 (LVD) の患者では,特にエジェクション分数 (EF) が減少した患者では,初期侵襲的戦略によって結果が改善される可能性があります. このアプローチは,HFとEFの35%から45%の高リスクサブグループで,よりよいイベントフリー生存を示しました.

キーワード:
心不全心筋動脈不全経皮冠動脈介入左心室機能障害

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科学分野:

  • 心臓病科
  • 介入心臓科
  • 心不全 の 治療

背景:

  • 安定した缺血性心臓病 (SIHD) の患者で,中程度の缺血性心臓病 (HF) または左心室機能不全 (LVD) がある患者は,複雑なサブグループを表します.
  • HF/ LVDと保存されたエジェクション分数 (EF) ≥35%のSIHD患者の最適の治療戦略 (侵襲的対保守的) は不明である.

研究 の 目的:

  • 初期侵襲的な戦略が,中程度の血栓不全とHF/LVDの anamnesisを有するSIHD患者の心血管的アウトカムを改善するかどうかを調査する.
  • HF/LVDの存在と重症度に基づいた侵襲的および保守的な戦略の成果を比較する.

主な方法:

  • LVEF ≥35%の5179人のSIHD患者を侵襲的または保守的な戦略にランダム化したISCHEMIA試験のデータ分析
  • HF/LVDの既往歴と未経験の参加者間の心血管のアウトカムを比較し,LVEFによって層分けした.

主要な成果:

  • HF/ LVDの患者は,HF/ LVDのない患者と比較して,より高い初期併発症と,より多くの主要な複合アウトカム (心血管疾患による死亡,心筋梗塞,または特定の入院) を経験しました.
  • HF/ LVDサブグループでは,保守的な戦略 (P相互作用=0. 055) に比べて,侵襲的な戦略は,より低いプライマリアウトカム率 (17. 2%対29. 3%) を示した.
  • HFとLVEFの35%から45%の小さな高リスクサブグループは,初期侵襲的なアプローチでよりよいイベントフリー生存を示しました.

結論:

  • SIHDの患者で,中程度の血栓不全とHF/ LVDの anamnesisがある患者は,不良心血管疾患のリスクが高くなります.
  • 高リスクのHF/LVD患者,特にLVEFの35%~45%の患者には,初期侵襲的戦略が有益であり,さらなる調査が必要である.