完整复血管化的时间按索引呈现分层,在工作时间和工作时间以外
Jacob J Elscot1, Hala Kakar1, Wijnand K den Dekker1
1Thorax Center, Department of Cardiology, Erasmus MC Cardiovascular Institute, Rotterdam, The Netherlands.
The American journal of cardiology
|May 22, 2024
概括
对于急性冠状动脉综合征,即时完全重血管 (ICR) 与分阶段完全重血管 (SCR) 一样安全,无论手术是在工作时间内还是工作时间外进行. 这一发现适用于患有多血管疾病的患者,结果没有显著差异.
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:
- 最近的试验表明,即时完全重血管 (ICR) 是分阶段完全重血管 (SCR) 的安全替代方案.
- 在急性冠状动脉综合征 (ACS) 中,ICR与SCR在工作时间和工作时间以外的比较有效性尚不清楚.
- 在工作时间的程序被定义为发生在周一至周五上午8点至下午6点之间的程序.
研究的目的:
- 评估皮肤冠状动脉干预 (PCI) 时间 (在工作时间内与工作时间以外) 对ICR与SCR策略的结果的影响.
- 根据ACS和多血管疾病患者的手术时间,评估ICR和SCR之间潜在的治疗差异效应.
主要方法:
- 来自BIOVASC试验的数据分析,该试验在工作时间内招募了1097名患者,在工作时间以外招募了428名患者.
- 利用考克斯回归模型分析1年随访后的初级复合结果 (全因死亡率,心肌梗塞,非计划性缺血驱动的再血管化,脑血管事件).
- 评估了程序时间 (在工作时间和工作时间之外) 和随机治疗分配 (ICR与SCR) 之间的乘法和加法相互作用.
主要成果:
- 在休息时间随机选择的患者更频繁地出现ST段升高心肌梗塞 (STEMI).
- 主要综合结局发生在8.4%的ICR和10.1%的SCR患者在上班时间 (HR 0.80;95%CI 0.54-1.19).
- 在工作时间外,主要复合结局发生在5.4%的ICR和7.7%的SCR患者中 (HR 0.69;95%CI 0.32-1.46),没有统计学上显著的相互作用 (p=0.70倍数,p=0.56添加值).
结论:
- 在对比急性冠状动脉综合征和多血管疾病患者的立即完全重血管 (ICR) 与分阶段完全重血管 (SCR) 时,没有观察到差异性治疗效应,无论程序是在工作时间内还是工作时间外进行.
- 在不同的程序时间窗口中,ICR与SCR的安全性和有效性似乎是一致的.
- 这些发现支持了针对ACS患者的完整重血管化策略的既定指南,无论干预的时间如何.
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