在心房动中预防中风的节奏控制或节奏控制策略:系统性审查和网络元分析
Andrea Galeazzo Rigutini1,2, Mara Graziani3, Gregory Y H Lip4,5
1Internal, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy. andreagaleazzorigutini@gmail.com.
概括
对于心房动 (AF) 患者,节律控制策略在使用适当的抗凝剂时,不会比控制速率更降低中风风险. 然而,导管切除降低了心力衰竭住院的数量.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 基于证据的医学基于证据的医学.
背景情况:
- 心房动 (AF) 是中风和血栓栓塞事件的重要危险因素.
- 目前AF的管理策略包括速度控制或节奏控制.
研究的目的:
- 为了比较节奏控制与节奏控制策略在减少AF患者中风和心血管事件的有效性.
- 评估特定的节律控制方法,包括抗不律性药物 (AAD),电动心脏转换和导管切除.
主要方法:
- 进行了随机对照试验 (RCT) 的系统搜索,比较速度和节律控制策略.
- 对21项涉及35,447名患者的RCT数据进行了网络元分析 (NMA).
- 同主结局包括发生在1年内和随机化后1年内发生的中风.
主要成果:
- 在任何时候考虑中风时,AAD-Alone显示风险较低 (OR 0.35),而AAD加电动心脏转换显示风险更高 (OR 4.01) 与速率控制相比.
- 当使用抗凝血剂≥70%时,中风风险的这些差异并不显著.
- 与率控制相比,导管切除显著减少了心力衰竭住院 (OR 0.38).
结论:
- 在AF患者中,节律控制对节律控制在中风预防方面的好处被适当的抗凝药所抵消.
- 导管切除在减少心力衰竭住院治疗方面具有显著的优势.
- 节律控制策略可能提供超出中风预防的好处,为AF管理提供个性化治疗方法.
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