针对非急性冠状动脉疾病的皮肤冠状动脉干预:20年的定量总结和网络元分析
Thomas A Trikalinos1, Alawi A Alsheikh-Ali, Athina Tatsioni
1Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
Lancet (London, England)
|March 17, 2009
概括
与医学治疗相比,冠状动脉疾病的导管治疗的连续创新,包括药物释放支架 (DES),并没有改善存活率或减少心脏病发作. 这些进步主要减少了对再血管化程序的需求.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在过去的20多年里,皮肤透光气球冠状动脉增生术 (PTCA),裸金属支架 (BMS) 和药物排泄支架 (DES) 已经发展成为冠状动脉疾病的导管治疗方法.
- 进行了随机试验的系统概述,以相互比较这些干预措施,并与非急性冠状动脉疾病的医疗治疗进行比较.
研究的目的:
- 系统地评估和比较PTCA,BMS,DES和医疗治疗在管理非急性冠状动脉疾病中的疗效.
- 评估穿皮冠状动脉干预的连续进步对临床结果 (如死亡,心肌梗塞和再血管化) 的影响.
主要方法:
- 在Medline上进行了系统的文献搜索,以确定符合条件的随机试验,比较四种干预措施中的至少两种.
- 随机效应元分析用于直接比较,网络元分析整合了直接和间接的证据.
- 关键结局包括死亡,心肌梗塞,冠状动脉旁路移植,目标损伤/血管再血管化以及任何再血管化.
主要成果:
- 纳入了61项涉及25388名患者的试验,调查了6项可能的比较中的4项;DES没有直接与医疗疗或PTCA进行比较.
- 通过皮肤冠状动脉干预 (PCI) 的进展与早期的方法或医学治疗相比,没有观察到死亡或心肌梗塞的显著改善.
- 在BMS与PTCA和DES与BMS相对应的顺序下,观察到目标病变或血管再血管化的显著减少.
结论:
- 与医疗治疗相比,对非急性冠状动脉疾病的导管治疗的连续创新并没有显示出对死亡率或心肌梗塞率的显著影响.
- 这些发现支持当前的建议,优先考虑优化医疗治疗作为非急性冠状动脉疾病患者的初始治疗策略.
相关概念视频
Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
Coronary Artery Disease V: Interprofessional Care
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...
Acute Coronary Syndrome V: Nursing Management
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...

