在怀疑冠状动脉疾病的初始压力测试与解剖测试后的生存率:PROMISE随机临床试验的长期随访
Pamela S Douglas1,2, Amanda Stebbins1, Borek Foldyna3
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
JAMA cardiology
|August 27, 2025
概括
对于疑似冠状动脉疾病 (CAD) 的冠状动脉计算机断层扫描 (CTA) 和压力测试之间的选择没有影响长期死亡率. 这两种诊断方法在10年内显示出类似的结果.
科学领域:
- 心脏病学
- 诊断成像
- 临床试验
背景情况:
- 冠状动脉疾病 (CAD) 的诊断通常依赖于非侵入性检测.
- 在PROMISE试验中,最初对有症状的患者进行了功能 (压力) 和解剖 (冠状动脉计算机断层扫描 (CTA)) 测试.
研究的目的:
- 在被随机分配到初始CTA或疑似CAD的压力测试的患者中确定长期死亡结果.
- 评估不同测试结果对死亡率的预后意义.
主要方法:
- 使用国家死亡指数对PROMISE随机临床试验 (2009-2014) 的2025年后续分析.
- 10,003名有症状的患者被随机分配到初始CTA或压力测试中.
- 随访时间中位数为10. 6年,主要终点为全因死亡.
主要成果:
- 在CTA和压力测试组 (14. 4%对14. 5%) 之间,所有原因的死亡率没有显著差异.
- 心血管死亡率也没有明显的差异,点估计有利于CTA.
- 异常CTA发现 (轻度,中度,严重) 显著提高了死亡的调整HR,而只有严重的压力测试异常具有预后意义.
结论:
- 最初的非侵入性测试选择 (CTA与压力测试) 没有影响疑似CAD患者的10年全因或心血管死亡率.
- 任何程度的冠状动脉疾病的CTA发现都增加了死亡风险.
- 选择最初的非侵入性检测策略似乎没有影响该患者群体的长期存活率.
更多相关视频
06:32Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
8.1K
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
24.4K
相关概念视频
01:30Acute Coronary Syndrome III: Diagnostic Studies
74
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
74
01:27Coronary Artery Disease V: Interprofessional Care
107
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
107
01:26Coronary Artery Disease IV: Preventive Measures
448
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
448
01:26Exercise Stress Test
659
Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
659