穿皮冠状动脉干预与非急性冠状动脉疾病的保守治疗:一个元分析
Demosthenes G Katritsis1, John P A Ioannidis
1Department of Cardiology, Athens Euroclinic, Athens, Greece.
Circulation
|June 2, 2005
概括
对于稳定的冠状动脉疾病 (CAD),穿皮冠状动脉干预 (PCI) 与医疗治疗相比并没有减少死亡或心肌梗塞. 除非患者最近有心肌梗塞,否则PCI没有益处.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 稳定的冠状动脉疾病 (CAD) 管理通常涉及皮肤冠状动脉干预 (PCI) 或保守的医疗治疗.
- 关于PCI对死亡率,心肌梗塞和稳定的CAD重血管化的影响的证据有限.
- 进行了一项元分析,将PCI与稳定的CAD患者的保守治疗进行比较.
研究的目的:
- 评估PCI与稳定冠状动脉疾病 (CAD) 患者保守医疗治疗的有效性.
- 评估PCI对死亡率,心肌梗塞和需要重血管化的影响.
主要方法:
- 11个随机试验的元分析.
- 包括2950名患者 (1476名PCI,1474名保守治疗).
- 分析结果,包括死亡率,心脏病死亡,心肌梗塞和重血管程序.
主要成果:
- 在PCI和保守治疗之间,死亡率,心脏病死亡,心肌梗塞,或需要冠状动脉旁路移植 (CABG) 或PCI之间没有显著差异.
- 对PCI与保守治疗的风险比率 (95%CI):死亡率为0.94 (0.72-1.24),心脏病死亡/MI为1.17 (0.88-1.57),非致命性MI为1.28 (0.94-1.75),CABG为1.03 (0.80-1.33),PCI为1.23 (0.80-1.90).
- 对PCI的潜在生存益处仅在最近心肌梗塞的患者中观察到 (风险比0.40,95% CI 0.17-0.95).
结论:
- 穿皮冠状动脉干预 (PCI) 对没有最近心肌梗塞的慢性稳定冠状动脉疾病 (CAD) 患者而言,与保守的医疗治疗相比,没有提供额外的好处.
- 在这组患者中,PCI并不能降低死亡,心肌梗塞或随后的再血管化风险.
- 这些发现表明,保守的医疗治疗是稳定的CAD患者的可行选择,为最近的心肌梗塞等特定症状保留PCI.
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