ISCHEMIA 試験における糖尿病患者の結果

Jonathan D Newman¹, Rebecca Anthopolos¹, G B John Mancini²

¹New York University Grossman School of Medicine (J.D.N., R.A., S.B., H.R.R., D.F.K., J.S.H.).

Circulation

|September 15, 2021

まとめ

糖尿病や慢性冠動脈疾患の患者はより高いリスクに直面しますが,医療療法のみよりも侵襲的な治療から追加の利益を得ることはありません. この発見は,この患者グループの治療戦略に影響を与えます.

科学分野:

心臓病科
糖尿病について
臨床試験

背景:

慢性冠動脈疾患 (CCD) の糖尿病患者は予後が悪い.
これらの患者に対する医療療法に加えて侵襲的な管理戦略の利点は不明である.

研究の目的:

侵襲的な治療が,保守的な治療と比較して糖尿病とCCDの患者の治療結果を改善するかどうかを評価する.
異なる患者のサブグループにおける侵襲的な治療効果の異質性を評価する.

主な方法:

ISCHEMIA試験では,CCD患者を侵襲的または保守的な戦略にランダムに割り当てました.
糖尿病は病歴,HbA1c値,または血糖低下薬の使用によって定義された.
ベイジアンアプローチでは,糖尿病と糖尿病のない患者の治療効果の異質性を分析した.

主要な成果:

糖尿病患者 (43%) は死亡または心筋梗塞 (MI) のリスクが49%増加しました.
追跡期間3.1年では,糖尿病患者 (54%) と糖尿病患者 (66%) の間では,無事生存率が低かった.
糖尿病患者と糖尿病患者との間で,侵襲的および保守的な戦略の間で,死亡またはMIの有意な違いは観察されなかった.

結論:

糖尿病とCCDの患者は,初期治療と比較して,通常の侵襲的な治療から利益を得ません.
侵襲的な戦略は,糖尿病集団内の臨床的または解剖学的サブグループ間で異なる効果を示さなかった.

キーワード:

ベイズ定理冠動脈疾患糖尿病糖尿病インスリン発症しない生存率腎不全,慢性左心室の機能

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