在被推进行冠状动脉血管造影的患者中进行第二意见试验的结果
T B Graboys1, B Biegelsen, S Lampert
1Lown Cardiovascular Center, Brookline, Mass.
JAMA
|November 11, 1992
概括
对于患有冠状动脉疾病的医疗稳定的患者,冠状动脉造血术通常可以安全地推迟. 这项研究表明,近50%的此类手术可能是不必要的,影响心脏护理决策.
科学领域:
- 心脏病学 心脏病学
- 临床试验设计 临床试验设计
背景情况:
- 冠状动脉扫描是诊断冠状动脉疾病的常见程序.
- 评估推迟血管造影的必要性和长期结果对于患者护理和资源配置至关重要.
研究的目的:
- 评估对建议进行冠状动脉血管造影的患者进行第二意见试验的可行性.
- 为了确定推迟手术的患者的长期结果.
- 建立有关冠状动脉血管造影的知情决策的标准.
主要方法:
- 采用了病例系列设计,根据患者的病例,推进行冠状动脉血管学第二意见.
- 随访包括问卷,电话和诊所访问.
- 收集关于心脏事件,干预,生活质量和症状的数据.
主要成果:
- 在168名患者中,134名 (80%) 被建议不要进行血管造影;28名 (16%) 的建议被推迟.
- 在平均46.5个月的随访期间,年化心脏病死亡率为1.1%,新发心肌梗塞为2.7%,不稳定性心痛为4.3%.
- 15.4%的患者最终接受了冠状动脉旁路或血管造形手术.
结论:
- 在医学上稳定的冠状动脉疾病患者中,冠状动脉扫描可以在很大一部分情况下安全地推迟.
- 研究结果表明,在美国,大约50%的冠状动脉血管造影可能是不必要的或可以推迟的.
- 仔细的患者选择和第二意见可以优化侵入性心脏手术的使用.
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