在患有多血管疾病和ST或非ST段升高急性冠状动脉综合征的患者中,立即或分阶段完全重血管化
Jacob J Elscot1, Hala Kakar1, Wijnand K den Dekker1
1Erasmus MC Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands.
International journal of cardiology
|June 14, 2025
概括
在急性冠状动脉综合征 (ACS) 患者中,立即完整的重血管化 (ICR) 对阶段性完整的重血管化 (SCR) 没有显著的两年益处. 观察到ICR事件的追赶迟到了,这表明没有长期优势.
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:
- 随机试验表明,立即完全重血管 (ICR) 是急性冠状动脉综合征 (ACS) 与多血管疾病阶段性完全重血管 (SCR) 的替代方案.
- 长期结果比较ICR和SCR在ST段的升高 (STE) 和非ST段的升高 (NSTE) ACS中并不成熟.
研究的目的:
- 为了比较ICR与SCR在ACS患者的2年结果.
- 评估ACS类型 (STE-ACS或NSTE-ACS) 是否影响ICR与SCR的治疗效果.
主要方法:
- 来自BIOVASC试验的2年随访数据的分析,该试验将ACS患者随机分为ICR或SCR.
- 主要复合终点:全因死亡率,心肌梗塞,非计划性缺血驱动的再血管化和脑血管事件.
- 考克斯回归分析,以评估STE/NSTE-ACS诊断对治疗效果的影响.
主要成果:
- 在608名STE-ACS患者中,2年初级复合终点发生率为ICR的10.9%,SCR的11.7% (P=0.71).
- 在NSTE-ACS患者中,2年初级复合终点发生率为ICR的13.5%,SCR的12.8% (P=0.90).
- 在STE-ACS和NSTE-ACS之间没有观察到显著的结果差异或治疗效果差异.
结论:
- 在初级和二级结果的2年随访中,ICR没有显示出与SCR相比的显著益处.
- 在STE-ACS和NSTE-ACS之间没有观察到ICR与SCR的差异效应.
- 在被随机分配到ICR的患者中,注意到累积事件率的潜在迟追赶.
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