安定した冠動脈疾患の侵襲的または保守的な管理後の生存率
Judith S Hochman1, Rebecca Anthopolos1, Harmony R Reynolds1
1NYU Grossman School of Medicine, New York, NY (J.S.H., R.A., H.R.R., S.B., Y.X., S.M., M.C., A.C., J.D.N., J.S.B., A.B.T.).
Circulation
|November 6, 2022
まとめ
慢性冠動脈疾患の患者では,最初の侵襲的な戦略では,保守的な治療と比較して全死亡率に違いはなかった. しかし,心臓血管疾患による死亡は減少したが,非心臓血管疾患による死亡は5. 7年間で増加した.
科学分野:
- 心臓病科
- 臨床試験
- 介入心臓科
背景:
- ISCHEMIA試験では,中等から重度の心血管疾患の管理戦略を調査した.
- 侵襲的アプローチと保守的なアプローチの間の主要なアウトカムにおいて,以前の発見は3.2年以上にわたって有意な違いを示さなかった.
研究 の 目的:
- ISCHEMIA試験の延長死亡追跡データを報告する.
- 初期侵襲的および保守的な戦略の間の全因,心血管,非心血管死亡率を比較する.
主な方法:
- 5179人の患者で初期侵襲的対保守的な戦略を比較したランダム化比較試験.
- 2021年12月まで 生命的状態の追跡調査を延長しました
- コックス回帰とベイジアン法を用いた分析で,不確定死亡を心血管疾患として分類した.
主要な成果:
- 7年後の全因死亡率では有意な差異はなかった (12. 7% 侵襲型 vs 13. 4% 保守型).
- 侵襲的戦略による7年間の心血管死亡率の低下 (6. 4% vs 8. 6%).
- 侵襲的戦略による7年間の非心血管性死亡率の上昇 (5. 6% 対 4. 4%).
結論:
- 慢性冠動脈疾患の患者の全死亡率は,初期侵襲的戦略によって変化しない.
- 侵襲的なアプローチは 心血管疾患による死亡率を低減するが,非心血管疾患による死亡率を増加させる.
- 多血管性疾患を含むサブグループでは治療効果の異質性が認められなかった.
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