对于患有急性冠状动脉综合征的老年患者的早期侵入性或保守性策略:元分析
Rohin K Reddy1,2, David Koeckerling3, Christian Eichhorn4
1National Heart and Lung Institute, Imperial College London, London, England.
JAMA internal medicine
|June 23, 2025
概括
对于患有急性冠状动脉综合征 (ACS) 的老年患者来说,早期的侵入性策略并没有减少全因死亡,但减少了复发性心肌梗塞 (MI) 和再血管. 然而,它增加了严重出血的风险,需要在治疗决策中仔细考虑.
科学领域:
- 心脏病学 心脏病学
- 临床医学 临床医学
- 基于证据的医学基于证据的医学.
背景情况:
- 对患有急性冠状动脉综合征 (ACS) 的老年患者进行最佳管理缺乏强有力的随机证据.
- 最近的大规模,长期随机试验为这一群体提供了新的数据.
研究的目的:
- 评估早期入侵策略与保守策略之间的关联以及70岁或以上患有ACS的患者的临床结果.
主要方法:
- 在MEDLINE,Embase和Cochrane控制试验中心注册册册的系统文献搜索,直到2024年10月.
- 包括随机试验,比较早期的侵入性与保守的治疗在ACS患者≥70年.
- 用固定效应和随机效应模型对聚合数据进行元分析,以确定相对风险和危险比率.
主要成果:
- 侵袭和保守策略之间的所有原因死亡没有显著差异 (RR,1.05;95% CI,0.98-1.11).
- 早期的侵入性策略减少了复发性心肌梗塞 (RR,0.78;95% CI,0.67-0.91) 和重复的冠状动脉再血管 (RR,0.43;95% CI,0.30-0.60).
- 侵入性策略与严重出血的风险增加有关 (RR,1.60;95% CI,1.01-2.53).
结论:
- 在老年ACS患者中,早期的侵入性策略与保守管理相比,并不能改善全因死亡率.
- 虽然减少了复发性心脏病发作和再血管化,但侵入性方法增加了严重出血的风险.
- 共享决策应权衡老年ACS患者的侵入性策略的竞争风险和益处.
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