急性冠状动脉综合征的立即 vs 延迟干预:一个随机临床试验
Gilles Montalescot1, Guillaume Cayla, Jean-Philippe Collet
1Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. gilles.montalescot@psl.aphp.fr
JAMA
|September 3, 2009
概括
与延迟干预相比,对没有ST段升高的急性冠状动脉综合征的立即干预并没有减少心肌梗塞. 该研究发现,这两种策略之间在峰值热素水平或关键次要终点上没有显著差异.
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:
- 国际指导方针建议在没有ST段升高的情况下对高危急性冠状动脉综合征 (ACS) 进行早期侵入性策略.
- 然而,对这些患者进行干预的最佳时间仍然不确定.
研究的目的:
- 为了比较立即干预与延迟干预在减少心肌梗塞 (MI) 在没有ST段升高的ACS患者中的有效性.
- 调查是否在入院时立即干预会比延迟干预带来更好的结果.
主要方法:
- 在急性冠状动脉综合征随机进行即时或延迟干预 (ABOARD) 的血管整形以抑制热素的上升是一个随机临床试验.
- 352名没有ST段升高的ACS患者和TIMI得分≥3被随机分为立即干预或延迟干预 (在入学后的下一个工作日,入学后8至60小时).
- 主要终点:峰值托波水平;关键次要终点:死亡,心脏病发作或1个月后紧急再血管化的复合结果.
主要成果:
- 立即干预涉及随机化,在70分钟内插入外,而延迟干预平均需要21小时.
- 在直接干预组和延迟干预组 (P = .70) 之间,在初级终点 (峰值热素I水平) 中没有发现显著差异.
- 关键次要终点发生在即时组的13.7%,而延迟组的10.2% (P = .31),在其他终点或重大出血中没有显著差异.
结论:
- 在没有ST段升高的ACS患者中,与推迟到下一个工作日 (平均21小时) 的干预策略相比,立即干预并没有减少心肌梗塞.
- 这项研究表明,延迟干预策略不逊色于对肌动脉梗塞的立即干预,根据峰值托罗邦水平来定义.
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