稳定冠状动脉疾病患者的分流储备导向皮肤冠状动脉干预的临床结果和成本效益:FAME 2试验的三年随访 (分流储备与多血管评估的血管学)
William F Fearon1, Takeshi Nishi2, Bernard De Bruyne3
1Division of Cardiovascular Medicine (W.F.F., T.N., M.A.H.) wfearon@stanford.edu.
Circulation
|November 4, 2017
概括
在稳定的冠状动脉疾病患者中,以分流储备为指导的穿皮冠状动脉干预 (PCI) 显著减少了主要的不良心脏事件和紧急再血管化. 这种方法证明了长期的成本效益,改善了患者的治疗结果.
科学领域:
- 心脏病学
- 干预心脏病学
- 健康经济学
背景情况:
- 之前的研究表明,单独通过血管造影指导的穿皮冠状动脉干预 (PCI) 与稳定的冠状动脉疾病 (CAD) 中的药物治疗 (MT) 相比,没有改善结果.
- 在FAME 2试验中,在稳定的CAD患者中,以分流储备 (FFR) 为指导的PCI与最佳MT进行了研究.
研究的目的:
- 根据FFR指导的PCI与稳定的CAD中单独使用MT的临床结果和成本效益的评估.
- 评估FFR指导的PCI对主要心脏不良事件 (MACE),再血管化和质量调整寿命 (QALY) 的影响.
主要方法:
- 888名FFR降低的稳定CAD患者被随机分为PCI+MT (n=447) 或单独MT (n=441).
- 在3年内评估了MACE (死亡,心肌梗塞,紧急再血管),成本和QALY.
- 使用欧洲生活质量-5维度 (EQ-5D) 调查来确定QALY的实用性.
主要成果:
- 在3年后,MACE在PCI组显著降低 (10. 1% 对比22. 0%,P< 0. 001),主要原因是急需再血管化的减少 (4. 3% 对比17. 2%,P< 0. 001).
- 在PCI组中,心痛的严重程度显著下降. 对于PCI,最初的成本较高,但3年后的总成本相似.
- 增量成本效益比 (ICER) 在2年后为17300美元/QALY,在3年后为1600美元/QALY.
结论:
- 减少FFR的病变的PCI显著改善了稳定的CAD患者的长期临床结果.
- 与单独的MT相比,以FFR为指导的PCI是一个经济上有吸引力的战略,在3年后期提供了相当大的价值.
相关概念视频
01:27Coronary Artery Disease V: Interprofessional Care
315
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...
315
01:27Peripheral Artery Disease III: Interprofessional Care
385
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
385
01:30Acute Coronary Syndrome III: Diagnostic Studies
309
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...
309