在非ST升高急性冠状动脉综合征中进行干预策略的5年结果:英国心脏基金会RITA 3随机试验
K A A Fox1, P Poole-Wilson, T C Clayton
1Centre for Cardiovascular Science, Department of Medical and Radiological Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK. k.a.a.fox@ed.ac.uk
Lancet (London, England)
|September 13, 2005
概括
对非ST升高急性冠状动脉综合征的早期侵入性策略显著降低了死亡或心肌梗塞的长期风险,特别是在高风险患者中. 与保守管理相比,这种方法在5年内改善了结果.
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:
- 在非ST升高急性冠状动脉综合征 (NSTE-ACS) 中,干预策略与保守方法的长期疗效尚不清楚.
- 本研究评估了与NSTE-ACS患者的缺血驱动血管学相比,常规血管学和再血管化的5年结果.
研究的目的:
- 为了比较早期干预策略的长期 (5年) 效果,与非ST升高急性冠状动脉综合征患者的保守策略进行比较.
- 为了确定常规血管造影和随后的再血管化是否与症状驱动程序相比改善了患者的结果.
主要方法:
- 一个多中心随机试验,涉及1810名NSTE-ACS患者,随机分配到早期干预 (n=895) 或保守策略 (n=915).
- 两组都接受了最佳的医疗治疗;干预组在72小时内接受了冠状动脉造影,并根据发现指导管理.
- 主要结局是死亡或非致命的心肌梗塞的综合结果,通过面具独立判断的治疗意向分析进行评估.
主要成果:
- 随访5年的中位数,干预组的死亡率或非致命性心肌梗塞率 (16.6%) 与保守组 (20.0%) 相比较低 (OR 0.78,p=0.044).
- 益处在高风险患者中最为明显,死亡或非致命心肌梗塞的几率比率在最高风险子组为0.44 (p=0.004).
- 干预组中心血管死亡或心肌梗塞的发生率也显著降低 (OR 0.74,p=0.030).
结论:
- 在NSTE-ACS患者的常规侵入性策略导致死亡或非致命的心肌梗塞风险的长期显著降低.
- 干预策略的好处主要在被确定为高风险的患者中观察到.
- 这些发现支持当前的指导方针,强调对急性冠状动脉综合征管理的强有力的风险分层.
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