在患有ST段升高急性心肌梗塞 (ASSENT-4 PCI) 的患者中,初级或基酶促进的皮肤通道冠状动脉干预:随机试验
Lancet (London, England)
|February 21, 2006
概括
在通过皮肤冠状动脉干预 (PCI) 治疗ST段升高心肌梗塞 (STEMI) 之前给定丁,增加了主要不良事件,包括死亡和中风. 这种方便的PCI方法不建议单独使用标准PCI.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 紧急医疗 紧急医疗
背景情况:
- 初级穿皮冠状动脉干预 (PCI) 是ST段升高急性心肌梗塞 (STEMI) 的首选治疗方法.
- 延迟PCI可能会对患者的结果产生负面影响.
- 调查减缓延迟的策略对于改善STEMI护理至关重要.
研究的目的:
- 评估在STEMI患者延迟PCI之前使用全剂量基甲的疗效和安全性.
- 为了确定这种便利的PCI策略是否与标准PCI相比减少了不良事件.
主要方法:
- 一项随机对照试验,涉及1667名STEMI患者,预计PCI延迟1-3小时.
- 患者被分配到标准PCI或PCI,然后先进行全剂量丁甲,阿司匹林和未分离的肝素.
- 主要终点是90天内死亡,充血性心力衰竭或休克的复合结果.
主要成果:
- 该研究因在方便PCI组的住院死亡率较高而提前停止.
- 方便性PCI与初级终点 (19%对13%) 的显著更高率和中风,再发作和重复血管化的增加率有关.
- 两组之间主要的非大脑出血并发症没有显著差异.
结论:
- 在STEMI患者的PCI前使用全剂量基甲的策略与主要不良事件的增加有关.
- 这种方便的PCI方法不推,并且比单独的标准PCI带来更高的风险.
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