相关实验视频
稳定的冠状动脉疾病的管理
Matthias E Pfisterer1, Michael J Zellweger, Bernard J Gersh
1Division of Cardiology, University Hospital, Basel, Switzerland. mpfisterer@uhbs.ch
Lancet (London, England)
|March 2, 2010
概括
对于轻度至中度的冠状动脉疾病,再血管化和药物治疗显示死亡和心脏病发作的类似结果. 压力测试和症状严重程度可以指导对入侵与保守治疗策略的决定.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 基于证据的医学基于证据的医学.
背景情况:
- 两个主要的试验,Courage和BARI-2D,研究了慢性稳定冠状动脉疾病的管理策略.
- 这些试验比较了重血管化与仅用药物的积极方法,产生了引发辩论的结果.
- 关于研究结果对没有血管造影的患者的概括性以及压力测试的作用仍然存在不确定性.
研究的目的:
- 审查冠状动脉疾病管理中的有争议的问题.
- 分析最近临床试验的优点和局限性.
- 为日常临床实践提出一个实用的治疗算法.
主要方法:
- 随机对照试验的审查,特别是 COURAGE 和 BARI-2D.
- 分析现有关于重血管化的数据与保守的药理疗法的分析.
- 基于临床发现和患者因素开发治疗算法.
主要成果:
- 在精选的患者群体中,在重血管和药物治疗之间,死亡率和心肌梗塞发生率没有显著差异.
- 在压力测试中,胸痛症状的严重程度和缺血的程度可以识别高风险患者.
- 个性化治疗策略可以根据患者的情况和偏好量身定制.
结论:
- 最佳的药理疗法和侵入性管理可以根据个体患者量身定制.
- 压力测试和症状评估对于识别可能受益于早期入侵策略的患者至关重要.
- 关于重血管化与保守管理的辩论仍在继续,个性化方法是关键.
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