在患有STEMI和多血管疾病的患者中,立即或分阶段完全重血管化
Paola Scarparo1, Jacob J Elscot1, Hala Kakar1
1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
概括
立即完全重血管 (ICR) 和分阶段完全重血管 (SCR) 在ST升高心肌梗塞 (STEMI) 患者中显示出类似的1年临床结果. 虽然ICR在30天后趋向于更好的结果,但从长远来看,这两种策略都是可比的.
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:
- 建议在ST升高心肌梗塞 (STEMI) 与多血管疾病 (MVD) 时进行完整的重血管化.
- 对于非罪祸首的病变再血管化的最佳时间仍然是争论的主题.
- 之前的试验支持在没有心脏性休克的情况下在STEMI患者中完全恢复血管.
研究的目的:
- 在MVD的STEMI患者中,比较立即完全重血管 (ICR) 与分阶段完全重血管 (SCR).
- 评估ICR与SCR对1年内关键临床结果的影响.
- 分析二次终点,包括死亡率,心肌梗塞和脑血管事件.
主要方法:
- 对BioVasc试验进行了预先规定的分析.
- 患有MVD的STEMI患者被随机分配到ICR或SCR组.
- 主要终点是所有原因的死亡率,心肌梗塞,计划外的再血管化或脑血管事件在1年的随访后的复合.
主要成果:
- 一年后,ICR和SCR组之间没有观察到主要终点的显著差异 (7.0%与8.3%,HR 0.84,p=0.55).
- 主要终点的各个组成部分,包括死亡率,心肌梗塞和脑血管事件,在两组之间没有显著差异.
- 在30天后,主要终点的下降趋势被发现,有利于ICR (3.0%对6.0%,HR0.50,p=0.09).
- ICR与显著较短的住院时间相关 (中位数为3天与4天,p<0.001).
结论:
- 一年后的临床结果与STEMI患者接受立即或分阶段完全重血管化的临床结果相似.
- 虽然立即的复血管化可能会提供早期的好处,并减少住院时间,但长期的结果与分阶段的程序相似.
- 这些发现有助于正在进行的关于STEMI患者MVD完整重血管化的最佳时间的讨论.
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