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新一代DES挑战CABG的远期死亡率优势

2015-07-14 小许 中国医学论坛报

近日,美国学者比较并发糖尿病的多血管疾病患者使用依维莫司洗脱支架行经皮冠状动脉介入术(PCI)和行冠状动脉旁路移植术(CABG)的早期与远期安全性结果公布。文章7月8日在线发表于《循环心血管介入》(Circ Cardiovasc Interv)杂志。 该研究使用纽约州登记数据中并发糖尿病的行CABG或PCI治疗多血管疾病的患者数据,经过倾向性评分筛

近日,美国学者比较并发糖尿病的多血管疾病患者使用依维莫司洗脱支架行经皮冠状动脉介入术(PCI)和行冠状动脉旁路移植术(CABG)的早期与远期安全性结果公布。文章7月8日在线发表于《循环心血管介入》(Circ Cardiovasc Interv)杂志。

该研究使用纽约州登记数据中并发糖尿病的行CABG或PCI治疗多血管疾病的患者数据,经过倾向性评分筛选出基线特征相似的一组患者队列(n= 8096)。分析结果显示,行PCI者较行CABG者术后早期死亡风险(风险比:0.58)和卒中风险(风险比:0.14)更低,但有更高心肌梗死(MI)风险(风险比:2.44)。远期看来,行PCI者和行CABG者死亡风险相似(10.50%对10.23%;p=0.16);行PCI者有更低卒中风险,但更高MI风险(在不完全血运重建者中),需要重复血运重建。

以上结果并不支持FREEDOM研究发现的CABG在远期死亡率方面的优势,主要研究者Sripal Bangalore博士表示:“实际上,FREEDOM研究公布之后,其结果在当今临床诊疗中的实用性一直存在争议——类似试验需要花费太多时间进行随访,最终结果出来的时候,新一代的支架已经投入临床使用。” FREEDOM研究使用的是西罗莫司洗脱支架和紫杉醇洗脱支架,而新发表研究使用的是依维莫司洗脱支架。

FREEDOM的主要研究者Michael Farkouh博士表示,他“非常怀疑”新一代的药物洗脱支架(DES)能够缩小PCI和CABG的远期死亡风险差距。对于新发表研究,Farkouh博士认为其随访时间(平均3年)过短,不足以辨别使用PCI和CABG的远期差异。Farkouh博士认为新发表研究或许证实了新一代DES相较于旧一代DES的某些优势,尤其是在减少支架血栓方面,但对并发糖尿病的多血管疾病患者来说,重要的不是靶病变,而是在PCI中未被干预的病变——这些才是导致术后18个月内心血管事件发生的罪魁祸首。并发糖尿病的多血管疾病患者的其他危险因素,如低密度脂蛋白胆固醇、高血压,也未被最好地控制。

Bangalore博士表示,无论CABG或PCI,如果可以降低患者的死亡率,就应该被提供给患者。但新研究显示CABG和PCI在远期死亡率上相差无几,那么患者就有权做出自己的选择。患者也许会想:“相对更高的卒中风险,我宁愿接受可能的再次血运重建。”

原始出处:

Sripal Bangalore, MD, MHA, Yu Guo, MA, Zaza Samadashvili, MD, Saul Blecker, MD, MHS, Jinfeng Xu, PhD and Edward L. Hannan, PhD, MS.Everolimus Eluting Stents Versus Coronary Artery Bypass Graft Surgery for Patients With Diabetes Mellitus and Multivessel Disease.Circulation: Cardiovascular Interventions.2015; 8: e002626 doi: 10.1161/CIRCINTERVENTIONS.115.002626

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    2015-07-16 fusion
  2. [GetPortalCommentsPageByObjectIdResponse(id=1558496, encodeId=0e41155849633, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564505, encodeId=5900156450517, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32783, encodeId=3b2032e8312, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32784, encodeId=632a32e841b, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32748, encodeId=bea632e485e, content=真是不错啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jul 14 12:23:00 CST 2015, time=2015-07-14, status=1, ipAttribution=)]
    2015-07-16 fusion
  3. [GetPortalCommentsPageByObjectIdResponse(id=1558496, encodeId=0e41155849633, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564505, encodeId=5900156450517, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32783, encodeId=3b2032e8312, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32784, encodeId=632a32e841b, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32748, encodeId=bea632e485e, content=真是不错啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jul 14 12:23:00 CST 2015, time=2015-07-14, status=1, ipAttribution=)]
    2015-07-14 medcardio

    药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1558496, encodeId=0e41155849633, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564505, encodeId=5900156450517, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32783, encodeId=3b2032e8312, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32784, encodeId=632a32e841b, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32748, encodeId=bea632e485e, content=真是不错啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jul 14 12:23:00 CST 2015, time=2015-07-14, status=1, ipAttribution=)]
    2015-07-14 medcardio

    药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1558496, encodeId=0e41155849633, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564505, encodeId=5900156450517, content=<a href='/topic/show?id=b68a586365' target=_blank style='color:#2F92EE;'>#DES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5863, encryptionId=b68a586365, topicName=DES)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=432c14994935, createdName=fusion, createdTime=Thu Jul 16 00:00:00 CST 2015, time=2015-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32783, encodeId=3b2032e8312, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=145, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32784, encodeId=632a32e841b, content=药物,支架和冠脉搭桥三种技术,螺旋式上升,相互pk。, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=96871613250, createdName=medcardio, createdTime=Tue Jul 14 19:47:00 CST 2015, time=2015-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=32748, encodeId=bea632e485e, content=真是不错啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Tue Jul 14 12:23:00 CST 2015, time=2015-07-14, status=1, ipAttribution=)]
    2015-07-14 owlhealth

    真是不错啊

    0

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