计算机断层扫描或侵袭性冠状动脉血管检查稳定胸痛后的健康状况结果:DISCHARGE随机临床试验的预规定的二次分析
, Nina Rieckmann1, Konrad Neumann1
1Institute of Public Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
JAMA cardiology
|May 14, 2025
概括
计算机断层扫描 (CT) 和侵入性冠状动脉血管学 (ICA) 策略在3.5年内对患者的生活质量 (QOL) 和胸痛产生了类似的影响. 女性患者的QOL较差,CT和ICA之间的结果没有显著差异.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 健康 结果 研究 研究 结果
背景情况:
- 计算机断层扫描 (CT) 与侵入性冠状动脉血管学 (ICA) 对患者健康状况的比较影响仍然不清楚.
- 稳定的胸痛患者中等冠状动脉疾病风险需要评估诊断策略对生活质量 (QOL) 和心痛的影响.
研究的目的:
- 评估CT与ICA对QOL和胸痛的首次测试策略,以评估CT与ICA对稳定胸痛和中等冠状动脉疾病风险患者的影响.
- 在大型随机临床试验中,将CT和ICA诊断途径之间的健康状况结果进行比较.
主要方法:
- 对于患有稳定胸痛和冠状动脉疾病中间风险的患者的诊断成像策略 (DISCHARGE) 试验随机将3561名患者进行CT或ICA.
- 主要结局包括患者报告的QOL测量 (EQ-5D-3L-VAS,SF-12 PCS) 和胸痛症状,评估时间为3.5年的中位随访期.
主要成果:
- 在CT和ICA组之间在3.5年后没有观察到QOL或心痛结局的显著差异.
- 这两种策略都导致了质量生活的改善,除了医院焦虑和抑郁度量-D得分,这只在CT组中得到改善.
- 与男性患者相比,女性患者在基线和随访时报告了较差的QOL,一些QOL措施的改善更大,但CT与ICA没有差异效应.
结论:
- CT和ICA在患有稳定的胸痛和中等冠状动脉疾病风险的患者中,在QOL和心痛结局方面表现出可比的有效性.
- 作为初始诊断策略,CT和ICA之间的选择不会显著影响长期健康状况.
- 无论最初的诊断方法如何,女性和男性患者之间的健康状况差异仍然存在,这凸显了针对性干预的必要性.
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