2015年至2023年间,冠状动脉疾病管理决策在现实世界实践中的变化:来自Evarest/BSE-NSTEP观察研究的见解
Casey L Johnson1, Samuel Krasner1, William Woodward1,2
1Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
更新的临床指导方针已经改变了压力心声学后中度缺血患者的管理方式,减少了侵入性血管学转诊. 冠状动脉干预率保持不变,这表明患者对手术的选择有所改善.
科学领域:
- 心脏病学 心脏病学
- 临床医学 临床医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 压力心声图是评估诱导性缺血的一个关键工具.
- 不断发展的临床指南和文献对心血管疾病管理产生影响.
- 现实世界的数据对于理解指南实施至关重要.
研究的目的:
- 评估更新的指导方针对应力心声回声学使用的影响.
- 评估在诱导性缺血病诊断后患者管理的变化.
- 分析侵袭性血管学转诊和干预的趋势.
主要方法:
- 分析了13819名在英国32家医院接受压力回声心脏成像 (2015-2023) 的患者.
- 两个阶段的比较:2015-2020年 (第一阶段) 和2020-2023年 (第二阶段).
- 通过NHS数字,对4,920名参与者的1年后续数据.
主要成果:
- 2期患者年轻,心血管风险较高.
- 在积极后应激心声图 (p<0.01) 导入侵性血管学转诊的显著减少.
- 干预率没有变化 (p=0.27),尽管转诊减少,特别是中度血缺血.
结论:
- 英国冠状动脉疾病管理途径发生了转变.
- 现在,中度血性缺血症患者接受侵入性血管造影的患者较少.
- 压力心声图似乎可以提高患者对侵入性手术的选择,尽量减少不必要的转诊.
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