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JACC:冠脉疾病合并糖尿病患者应选择怎样的药物治疗和血运重建方案?

2016-08-30 fsy 译 MedSci原创

目前,通过详细的冠状动脉疾病或左室射血分数(LVEF)血管造影负担分层的2型糖尿病和稳定冠状动脉疾病(CAD)患者的结果数据还比较少。 这项研究确定了最佳药物治疗(OMT)(有或没有经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)的情况下)对LVEF的长期结果和病变血管数量的影响,包括左前降支近端动脉病变。 来自加拿大的研究人员在3项临床试验中进行了患者水平的汇集

目前,通过详细的冠状动脉疾病或左室射血分数(LVEF)血管造影负担分层的稳定冠状动脉疾病(CAD)合并2型糖尿病患者的结果数据还比较少。

这项研究确定了最佳药物治疗(OMT)(有或没有经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)的情况下)对LVEF的长期结果和病变血管数量的影响,包括左前降支近端动脉病变。

来自加拿大的研究人员在3项临床试验中进行了患者水平的汇集分析。主要终点是死亡和心肌梗死(MI)的复合终点,或卒中,并且研究人员还对试验和随机化策略进行了调整。

在5034例受试者中,15%的患者LVEF<50%,77%的患者有多支冠脉病变,28%有左前降支近端动脉病变。在中位随访4.5年期间,对于主要终点(风险比[HR]:0.71;95%可信区间[CI]:0.59至0.85;P=0.0002),死亡(HR为0.76;95%可信区间:0.60至0.96;P=0.024),和MI(HR为0.50;95%可信区间:0.38至0.67;P=0.0001),CABG+OMT优于PCI+OMT,但对于卒中而言,效果并非如此(HR为1.54;95%可信区间:0.96至2.48;P=0.074)。对于主要终点的预防(HR:0.79;95%可信区间:0.64,0.97;P=0.022)和MI(HR为0.55;95%可信区间:0.41,0.74;P=0.0001),CABG+OMT优于单独OMT治疗,对于3支血管病变CAD患者(HR为0.72;95%可信区间:0.58,0.89;P=0.002)和LVEF正常患者的主要终点(HR为0.71;95%可信区间:0.58,0.87;P=0.0012),CABG+OMT优于PCI+OMT治疗。OMT与OMT+PCI相比无显著差异。

通过对稳定CAD合并T2D患者的长期随访发现,CABG+OMT降低了主要终点的发生率,因此该研究支持将CABG+OMT作为稳定冠脉疾病合并2型糖尿病患者的首选的治疗策略。

原始出处:

G.B. John Mancini,Michael E. Farkouh,Maria M. Brooks,et al.Medical Treatment and Revascularization Options in Patients With Type 2 Diabetes and Coronary Disease,JACC,2016.8.30

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    2017-03-14 hbwxf
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    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

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objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 10:24:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-05 李东泽

    很好,不错,以后会多学习

    0

  4. 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topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Thu Sep 01 05:42:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1572976, encodeId=70cc15e297632, content=<a href='/topic/show?id=805d3098599' target=_blank style='color:#2F92EE;'>#冠脉疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30985, encryptionId=805d3098599, topicName=冠脉疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb3e15794072, createdName=huangshifeng, createdTime=Thu Sep 01 05:42:00 CST 2016, time=2016-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474041, encodeId=e9ae14e40415f, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, 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objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 10:24:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-02 1771ae4158m

    学习一下,好

    0

  5. 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objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 10:24:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-09-02 慧读

    继续关注

    0

  6. 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  7. 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  8. 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  9. 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objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=ebe61630855, createdName=1dd8a7c5m95(暂无匿称), createdTime=Wed Aug 31 10:24:00 CST 2016, time=2016-08-31, status=1, ipAttribution=)]
    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

    0

  10. 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    2016-08-31 1dd8a7c5m95(暂无匿称)

    学习了,赞一个!!!

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