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重复啦JACC:急性心衰患者越早给予袢利尿剂 死亡风险越低

2017-07-21 吴刚 环球医学

2017年6月,发表在《J Am Coll Cardiol》的一项由荷兰、日本和美国科学家进行的前瞻性、多中心、观察性队列研究,发现急性心衰患者越早开始呋塞米治疗,死亡风险越低。



2017年6月,发表在《J Am Coll Cardiol》的一项由荷兰、日本和美国科学家进行的前瞻性、多中心、观察性队列研究,发现急性心衰患者越早开始呋塞米治疗,死亡风险越低。

背景:急性心衰(AHF)是威胁生命的一种疾病,需要紧急治疗,包括立即开始袢利尿剂。

目的:前瞻性评估利尿剂治疗时机和临床结局之间的相关性。

方法:REALITY-AHF(关注于急性心衰急诊中的非常早期表现和治疗的注册)是一项前瞻性、多中心、观察性队列研究,首要目的为评估急诊(ED)AHF患者中,髓袢利尿剂开始治疗的时机和临床结局之间的相关性。开始呋塞米治疗的时机(D2F)定义为从患者抵达急诊到首次静脉注射呋塞米的时间。D2F时间<60分钟的患者预先定义为早期治疗组。首要结局为全因院内死亡率。

结果:1291名抵达急诊的24小时内静脉注射呋塞米的AHF患者中,中位D2F时间为90分钟(IQR,36~186分钟),481人(37.3%)为早期治疗组。相比于非早期治疗组,早期治疗组的患者更可能通过救护车送到急诊,具有更多的充血体征。早期治疗组的院内死亡率显着性低(2.3% vs 6.0%;P=0.002)。多变量分析中,早期治疗仍然与较低的院内死亡率显着相关(比值比,0.39;95% CI,0.20~0.76;P=0.006)。

结论:在本项前瞻性、多中心、观察性队列研究中,急诊就诊的AHF患者,早期静脉注射袢利尿剂与较低的院内死亡率相关。(关注于急性心衰急诊中的非常早期表现和治疗的注册:UMIN000014105)

原始出处:

Matsue Y, Damman K, Voors AA,et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol. 2017 Jun 27;69(25):3042-3051. doi: 10.1016/j.jacc.2017.04.042.

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    2018-03-04 hbwxf
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Eur J Heart Fail:研究确定糖尿病的又一致命并发症

在一项新的研究中,研究人员发现了糖尿病和急性心衰之间的关系。研究人员比对了单纯急性心衰患者和糖尿病急性心衰患者,结果发现,他们与炎症,心血管功能和肾脏健康相关的生物标记物都存在着明显的不同。

EUR HEART J:经皮短期主动机械支持装置在心源性休克中的应用

这项荟萃分析的结果不支持对CS患者无选择地使用主动MCS,有可能加重AMI。

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