针对心肌梗塞的多血管PCI进行完整重血管化的时间
Barbara E Stähli1, Ferdinando Varbella1, Axel Linke1
1From the Department of Cardiology, University Heart Center, University Hospital Zurich, the Center for Translational and Experimental Cardiology, and the Faculty of Medicine (B.E.S., R.K., P.J., J.S., A.C., C.T., M. Schindler, W.M., F.R.) and Center for Molecular Cardiology, University of Zurich (T.F.L.), Zurich, the Department of Cardiology, Bern University Hospital, University of Bern, Bern (M.R.), and Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano (M.M.) - all in Switzerland; the Department of Internal Medicine, Cardiology Unit, Rivoli Hospital, Turin (F.V., G.Z., G.Q.), the Department of Internal Medicine, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria (M.V.), and the Division of Cardiology, Parma University Hospital, Parma (G.M.) - all in Italy; Technische Universität Dresden, Department of Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Dresden (A.L., N.M.), the Heart Center, Segeberger Kliniken, Academic Teaching Hospital for the Universities of Kiel, Lübeck and Hamburg, Bad Segeberg (B.S., G.R.), the Department of Internal Medicine B, University Medicine Greifswald, and the German Center for Cardiovascular Research (DZHK) Partner Site Greifswald, Greifswald (S.B.F.), the Department of Cardiology, University Heart and Vascular Center Hamburg, Center for Population Health Innovation, University Clinic Hamburg-Eppendorf, and DZHK Partner site Hamburg/Kiel/Lübeck, Hamburg (M. Seiffert, P.C.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau (B.W.), the Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen (L.G., S.A.), Cardiology and Pneumology, Klinikum Landkreis Erding, Erding (L.B.-F.), FB Mathematics and Computer Science, University of Bremen, Bremen (M.W.), the Department of Cardiology, Ulm University Heart Center, Ulm (M.K., W.R.), the Department of Cardiology and Angiology, University of Freiburg Medical Center, and the Faculty of Medicine, University of Freiburg, Freiburg (C.V., F.-J.N.), the Department of Cardiology, University Medical Center Mainz, and the Center for Cardiovascular Research, Johannes Gutenberg University Partner Site Rhine Main, Mainz (T.M.), the Department of Internal Medicine I, Division of Cardiology, Pneumology, and Angiology, and the Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena (P.C.S.), Clinic and Policlinic Internal Medicine I, Cardiology and Angiology, Klinikum rechts der Isar (K.-L.L.), and Klinik für Herz und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, and DZHK, partner site Munich Heart Alliance (A.K.), Munich, and Institut für Herzinfarktforschung, Ludwigshafen (S.S.) - all in Germany; the Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna (I.M.L., A.T.), the 3rd Department of Medicine, Cardiology, and Intensive Care Medicine, Clinic Ottakring and Sigmund Freud University Medical School (M.R., K.H.), and the 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse (F.W.) - all in Vienna; the Department of Cardiovascular Diseases, University of Medicine, University Hospital Mother Teresa, Tirana, Albania (A.D.); the Department of Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark (P.C.); and the Heart Division, Royal Brompton and Harefield Hospitals, and the National Heart and Lung Institute, Imperial College London, London (T.F.L.), and the Robertson Centre for Biostatistics, University of Glasgow, Glasgow (I.F.) - all in the United Kingdom.
在ST升高心肌梗塞 (STEMI) 患有多血管疾病的患者中,立即的多血管穿皮冠状动脉干预 (PCI) 与分阶段的PCI无差. 这种方法在一年内显著减少了重大不良事件.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 在多血管冠状动脉疾病的STEMI患者中,完全重血管化的最佳时间尚未确定.
- 目前的指导方针缺乏对这种患者群体的非致病病变治疗的最终建议.
研究的目的:
- 为了比较立即与分阶段的多血管PCI在血动力稳定的多血管冠状动脉疾病的STEMI患者中的疗效和安全性.
- 为了确定即时完全的再血管化是否与关键临床结果的分阶段方法相比不逊色.
主要方法:
- 一个国际性的,开放的,随机的,非劣等性试验,涉及37个欧洲站点.
- 患有STEMI和多血管冠状动脉疾病的患者被随机分配到即时的多血管PCI或罪祸首病变PCI,然后在19-45天内分阶段的多血管PCI.
- 主要终点是所有原因的死亡,非致命的心肌梗塞,中风,无计划的缺血驱动的再血管化或1年内心力衰竭住院治疗的复合结果.
主要成果:
- 总共有840名患者被随机分配 (418名立即,422名分阶段).
- 主要终点发生在即时组的8.5%,相对于分阶段组的16.3% (风险比率0.52;P<0.001的非劣势和优势).
- 在直接治疗组中,观察到非致命的心肌梗塞和非计划的重血管化发生的具体减少. 死亡,中风和心力衰竭住院的风险在各组之间相似.
结论:
- 立即多血管PCI是血液动力学稳定的多血管冠状动脉疾病的STEMI患者的安全和有效策略.
- 立即方法表明与分阶段PCI无劣,并在一年内显著减少主要心血管不良事件.
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