基于冠状动脉疾病和缺血严重性的ISCHEMIA试验结果
Harmony R Reynolds1, Leslee J Shaw2, James K Min3
1New York Universty Grossman School of Medicine (H.R.R.., S.B., J.D.N., J.S.H.).
Circulation
|September 9, 2021
概括
在ISCHEMIA试验中发现,虽然严重的冠状动脉疾病 (CAD) 增加了死亡风险,但缺血的严重程度并不能独立预测结果. 在稳定的CAD和中度至重度缺血患者中,侵入性治疗没有降低整体死亡率.
科学领域:
- 心脏病学
- 临床试验
- 医学有效性研究
背景情况:
- 在ISCHEMIA试验中,研究了重血管化是否有利于稳定冠状动脉疾病 (CAD) 和中度至重度缺血的患者.
- 这项分析专门研究了基于管理策略的CAD和缺血严重程度如何影响试验结果.
研究的目的:
- 确定冠状动脉疾病 (CAD) 和心肌缺血的严重程度之间的关系,以及它们对ISCHEMIA试验的临床结果的影响.
- 评估缺血症严重程度是否能确定初步侵袭治疗策略与保守治疗策略相比有好处的患者子组.
主要方法:
- 5179名中度/重度缺血患者被随机分配到侵袭性或保守的策略中.
- 冠状动脉计算机断层扫描评估了CAD解剖学;杜克预后指数分类了CAD严重程度 (n=2475).
- 使用各种成像方法 (n=5105) 评估缺血症的严重程度,并对各个子组的4年事件率进行比较.
主要成果:
- 与轻度缺血或没有缺血相比,中度缺血和严重缺血都没有独立增加死亡风险 (HR分别为0. 89和0. 83).
- 随着缺血症的严重程度的增加,非致命心肌梗塞 (MI) 的发生率呈上升趋势 (趋势P=0. 04).
- 较高的CAD严重程度与死亡 (HR 2.72) 和心脏病发作 (HR 3. 78) 的风险增加有关. 侵袭性策略显示,在最严重的CAD亚组中,心血管死亡或心肌梗塞的趋势较低,但所有原因死亡率没有差异.
结论:
- 仅仅因缺血症的严重程度而调整后,并没有预测增加的风险;更严重的CAD是显著的风险因素.
- 最初的侵入性治疗策略在任何缺血或CAD严重性小组中都没有降低4年全因死亡率.
- 研究结果表明,在稳定性缺血性心脏病中,风险分层和管理决策的重点是缺血性心脏病的严重程度,而不是缺血的严重程度.
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