老年患有心肌梗塞的老年患者的侵入性治疗策略
Vijay Kunadian1, Helen Mossop1, Carol Shields1
1From the Translational and Clinical Research Institute, Faculty of Medical Sciences (V.K.), the Population Health Sciences Institute (H.M., M.D.T.), and the Newcastle Clinical Trials Unit (C.S., M. Bardgett, P.W., M.D.T., J.P.), Newcastle University, and the Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust (V.K., J.A.H., I.U.H.), Newcastle upon Tyne; Northumbria Healthcare NHS Foundation Trust, Cramlington (C.R., D.P.R.); the Faculty of Health Sciences and Wellbeing, School of Medicine, University of Sunderland Medical School, Sunderland (D.P.R.); North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees (J. Carter, J.Q.); Chesterfield Royal Hospital, Chesterfield (J. Cooke); South Tees NHS Foundation Trust, Middlesbrough (D.A.); County Darlington and Durham NHS Foundation Trust, Darlington (J. Murphy); Royal Derby Hospital, Derby (D.K.); University Hospital Ayr, Ayr (J. McGowan); Leeds Teaching Hospital NHS Trust, Leeds (M.V.); Torbay and South Devon NHS Foundation Trust, Torquay (D.F.); Manchester University NHS Foundation Trust, Manchester (H.C.); Epsom and St. Helier University Hospitals, Epsom (S.M.); Ninewells Hospital, Dundee (J.I.); Bradford Royal Infirmary, Bradford (S.L.); Blackpool Victoria Hospital, Blackpool (G.G.); United Lincolnshire Hospitals NHS Trust, Lincoln (K.L.); Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan (A.S.); North Bristol NHS Trust, Bristol (A.G.D.); University Hospital of Leicester NHS Trust, Leicester (S.H.); Barts Health NHS Trust (M. Belder) and London School of Hygiene and Tropical Medicine (S.J.P.), London; the Centre for Cardiovascular Science, University of Edinburgh, Edinburgh (M.D., D.E.N., K.A.A.F.); Norwich Medical School, University of East Anglia, Norwich (M.F.); and Sheffield Teaching Hospital, Sheffield (R.F.S.) - all in the United Kingdom.
对于患有非ST段升高心肌梗塞 (NSTEMI) 的老年人来说,侵入性策略与保守医学治疗相比没有显著的益处. 这项研究发现,两种方法之间的心血管死亡或非致命心脏病发作率相似.
科学领域:
- 心脏病学 心脏病学
- 老年医学 老年医学
- 临床试验 临床试验
背景情况:
- 对于非ST段升高心肌梗塞 (NSTEMI) 的老年人来说,最佳的治疗策略仍然不确定.
- 在这个人口群体中,保守医学治疗和侵入性干预之间的平衡需要进一步调查.
研究的目的:
- 为了比较保守的医疗治疗策略与老年人 (≥75岁) 的侵袭性策略 (冠状动脉血管学和再血管化) 的疗效,使用NSTEMI.
- 为了评估心血管死亡或非致命心肌梗塞的复合结果在脆弱的老年患者与NSTEMI.
主要方法:
- 一项前性多中心随机试验 (SENIOR-RITA) 涉及1518名75岁或以上的NSTEMI患者.
- 患者被随机分配1:1到保守的医疗治疗组或侵入性策略组.
- 主要结局是心血管死亡或非致命心肌梗塞的组合,通过时间到事件方法分析,平均随访时间为4.1年.
主要成果:
- 在入侵性 (25.6%) 和保守性 (26.3%) 策略组之间没有观察到主要复合结果的显著差异 (危险比,0.94;95% CI,0.77至1.14).
- 非致命的心肌梗塞发生的频率较少在侵袭性组 (11.7%) 与保守组 (15.0%) 相比 (危险比率,0.75;95% CI,0.57到0.99).
- 心血管疾病死亡率在各组之间相似,手术并发症不到1%.
结论:
- 与NSTEMI的老年人保守策略相比,侵入性策略没有显著降低心血管死亡或非致命心肌梗塞的风险.
- 这些发现表明,对老年NSTEMI患者,包括那些脆弱的患者来说,保守的治疗是可行的选择.
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