根据ISCHEMIA试验的冠状动脉再血管化方式的结果
Bjorn Redfors1, Gregg W Stone2, John H Alexander3
1Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Gothenburg, Sweden; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.
Journal of the American College of Cardiology
|November 13, 2023
概括
伊斯凯米亚试验发现,虽然通过皮肤冠状动脉干预 (PCI) 或冠状动脉旁路移植 (CABG) 进行早期再血管化增加了短期心血管风险,但与稳定的冠状动脉疾病的保守医学治疗相比,它降低了长期风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 在ISCHEMIA试验之前,在稳定的冠状动脉疾病中,侵入性 (穿皮冠状动脉干预[PCI]或冠状动脉旁路移植[CABG]) 与保守 (CON) 策略相比,已经确定了类似的缺血事件风险.
- 这项分析专门研究了在侵袭性手臂内接受PCI或CABG治疗的患者的结果.
研究的目的:
- 单独分析接受PCI和CABG治疗的患者在稳定冠状动脉疾病的结果.
- 为了比较PCI,CABG和保守管理之间的重大心血管不良事件的早期和晚期风险.
主要方法:
- 患者被分为入侵性PCI (INV-PCI),入侵性CABG (INV-CABG) 或保守 (CON) 组.
- 主要结局是心血管死亡,心肌梗塞或因心痛不稳定而入院,心力衰竭或恢复性心脏骤停的复合结果.
- 结果从再血管化或随机化时进行分析,重点关注30天内及之后的事件.
主要成果:
- 主要结局事件的发生率为INV-CABG的16.4%,INV-PCI的9.8%,CON患者的13.6%.
- 在CABG (HR: 16.25) 和PCI (HR: 2.99) 后,早期风险 (在30天内) 显著增加,主要是由于手术性心肌梗塞 (MIs).
- 与CON策略相比,CABG (HR:0.63) 和PCI (HR:0.66) 后的长期风险 (超过30天) 较低.
结论:
- 在稳定的冠状动脉疾病中,通过PCI或CABG进行早期再血管化与早期心血管风险的增加有关,特别是在CABG后由于手术MIs.
- 然而,与保守的医学治疗相比,这些侵入性策略显示了长期心血管事件风险的显著降低.
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