在怀疑冠状动脉疾病的稳定门诊患者中推迟测试:精确的随机临床试验的预规定的二次分析
James E Udelson1, Michelle D Kelsey2, Michael G Nanna3
1Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
JAMA cardiology
|August 23, 2023
概括
对疑似冠状动脉疾病 (CAD) 的低风险个体推迟诊断测试是安全有效的. 这一策略导致不必要的手术减少,并且与通常的护理相比,同样缓解了症状.
科学领域:
- 心脏病学 心脏病学
- 诊断策略 诊断策略
- 临床试验 临床试验
背景情况:
- 指导方针建议推迟对疑似冠状动脉疾病 (CAD) 和低预测概率的有症状的个体进行测试.
- 没有任何随机试验能够前性地评估这种策略.
研究的目的:
- 评估当测试被推迟时被确定为CAD风险最小的人的护理过程和健康结果.
- 用PROMISE最小风险得分 (PMRS) 来指导测试决策来评估精度策略的安全性和有效性.
主要方法:
- 一个随机的,务实有效性试验 (PRECISE试验子组) 涉及2103名参与者在65个地点.
- 被PMRS确定为最小风险的参与者被随机分配到精确策略 (延迟测试) 或常规测试中.
- 主要终点是所有原因死亡,非致命的心肌梗塞 (MI) 或在12个月内没有阻塞性CAD的导管治疗的复合结果.
主要成果:
- 在422名风险最小的参与者中,214人被随机分配到延期测试中,208人被分配到常规测试中.
- 主要终点发生在延迟测试组的0.9%,通常测试组的6.3% (HR,0.15;P=.01).
- 在延迟测试组中没有观察到死亡或心脏病发作;在两组中,症状缓解是相似的.
结论:
- 在疑似CAD的症状参与者中,以PMRS为指导的最小风险识别策略和最初推迟的测试是安全的.
- 这一策略导致了较少的导管注射,没有阻塞性CAD,并且与通常的测试相比可以缓解症状.
- 这些发现支持使用PMRS来指导在某些可疑患有CAD的患者中推迟测试策略.
更多相关视频
相关概念视频
Acute Coronary Syndrome III: Diagnostic Studies
10
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...
10
Coronary Artery Disease V: Interprofessional Care
9
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...
9
Coronary Artery Disease IV: Preventive Measures
23
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
23
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
39
Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
39
Coronary Artery Disease III: Clinical Manifestations
13
Coronary Artery Disease (CAD) is a primary health risk worldwide, leading to significant morbidity and mortality. The condition arises from the buildup of atherosclerotic plaques within the coronary arteries, resulting in diminished blood supply to the heart muscle.The clinical manifestations of CAD vary widely, from asymptomatic stages to severe, life-threatening conditions. Understanding these manifestations is crucial for early diagnosis and effective management.Angina Pectoris: The Warning...
13
Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
13
Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
13


