为左主冠状动脉疾病进行再血管化治疗的患者的B型尿酸评估:EXCEL试验的分析
Björn Redfors1, Shmuel Chen1, Aaron Crowley1
1Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., S.C., A.C., O.B.-Y., G.W.S.).
Circulation
|April 19, 2018
概括
在左主冠状动脉疾病患者中,B型尿酸 (BNP) 的升高预示着重血管化后的较高死亡率. 通过皮肤冠状动脉干预与旁路移植的治疗结果可能取决于基线BNP水平.
科学领域:
- 心脏病学
- 干预心脏病学
- 临床试验
背景情况:
- B型尿酸 (BNP) 的升高表明心脏功能受损,冠状动脉疾病 (CAD) 的预后更差.
- 左主冠状动脉需要重新血管,通过皮肤冠状动脉干预 (PCI) 和冠状动脉旁路移植 (CABG) 是主要的选择.
研究的目的:
- 评估基线BNP水平与左主CAD患者的不良结果之间的关联.
- 根据这些患者的基线BNP水平,评估PCI与CABG的相对疗效.
主要方法:
- 分析了EXCEL试验的数据,随机分配左主CAD患者到PCI或CABG.
- 多变量考克斯回归用于评估BNP水平 (正常与升高,≥100 pg/ mL) 与3年不良事件之间的关联.
- 探讨BNP水平与再血管化策略之间的治疗相互作用.
主要成果:
- 在39. 5%的患者中观察到基线BNP升高,并且与3年内主要复合终点 (死亡,心脏病发作,中风) 和全因死亡率的增加有关.
- 在正常和高BNP组之间没有发现非致命性缺血事件或出血的显著差异.
- 观察到基线BNP水平与治疗策略 (PCI与CABG) 之间存在显著的相互作用,这表明基于BNP状态的结果有所差异.
结论:
- 基线BNP升高可独立预测左主CAD患者的长期死亡率.
- 在PCI和CABG之间的选择中,可能需要考虑基线BNP水平,因为长期结果可能有差异.
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