在新设备时代,患有功能衰竭的患者是否是穿皮冠状动脉再血管化的良好候选人?
M H Rubenstein1, L C Harrell, B V Sheynberg
1Cardiac Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Circulation
|January 11, 2000
概括
经过皮肤冠状动脉干预的功能衰竭患者的风险更高,但新设备的结果有所改善. 支架和除技术提高了这些复杂的患者的成功率.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 干预心脏病学 干预心脏病学
背景情况:
- 患有末期病 (ESRD) 的患者在常规气球血管整形手术中面临着挑战.
- 这包括程序成功率降低和并发症率增加.
研究的目的:
- 评估皮肤冠状动脉干预 (PCI) 对不同程度衰竭的患者的即时和长期结果.
- 评估现代设备对这些结果的影响.
主要方法:
- 一项对362名功能衰竭患者 (肌素>1.5毫克/分升) 和2972名具有正常功能患者的比较研究.
- 1994年至1997年间收集的数据,比较了即时和长期结果.
- 统计分析包括后勤回归和考克斯回归.
主要成果:
- 患有功能衰竭的患者年龄较大,并患有更多的并发症,治疗成功率较低 (89.5% vs 92.9%) 和住院主要不良心脏事件 (MACE) 较高 (10.8% vs 1.8%).
- 功能衰竭是MACE的独立预测因素 (OR, 3.41).
- 长期随访显示,功能衰竭患者的生存率较低 (27.7%vs6.1%),MACE率更高 (51%vs33%). 透析和非透析患者的结局类似.
结论:
- 尽管增加了风险,但在功能衰竭患者中,PCI可以通过现代设备实现高的程序成功率.
- 支架和除技术显著改善了这一群体的直接和长期结果.
- 功能衰竭仍然是PCI后心脏不良事件的重要预测因素.
相关概念视频
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
1.9K
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.9K
Cardiac Catheterization I: Pre-Procedure Overview
3.4K
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
3.4K
Coronary Artery Disease V: Interprofessional Care
444
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
444
Peripheral Artery Disease III: Interprofessional Care
655
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
655
Continuous Renal Replacement Therapy
2.3K
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
2.3K
Kidney Transplant I: Introduction
827
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
827


