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NEJM:晚期肾病的患者,出现中重度心肌缺血时,保守治疗还是侵入性治疗?

2020-04-04 MedSci MedSci原创

美国纽约大学格罗斯曼医学院Sripal Bangalore课题组的一项最新研究,探讨了晚期肾病患者冠状动脉疾病的管理策略。相关论文发表在2020年3月30日出版的《新英格兰医学杂志》上。

美国纽约大学格罗斯曼医学院Sripal Bangalore课题组的一项最新研究,探讨了晚期肾病患者冠状动脉疾病的管理策略。相关论文发表在2020年3月30日出版的《新英格兰医学杂志》上。

常规临床试验中,评估稳定型冠心病患者血运重建疗效时,往往排除了晚期慢性肾病的患者。但是,这类患者容易出现心血管事件。对于这类患者出现中重度心肌缺血时,选择PCI或CABG还是保守治疗,目前还没有结论。

研究组招募了777名晚期肾病、中度或重度缺血的患者,将其随机分组,分别接受初始侵入性治疗(包括冠脉造影和血运重建)联合药物治疗,或仅初始药物治疗的保守方案,保守治疗失败则行血管造影术。主要结局是死亡或非致命性心肌梗死的复合终点。关键次要结局是死亡,非致命性心肌梗死,或因不稳定型心绞痛、心力衰竭或心脏骤停复苏而住院的复合终点。

中位随访2.2年后,侵入性治疗组中有123例患者发生主要结局事件,保守方案组有129例,估计3年事件发生率分别为36.4%和36.7%,校正后的风险比为1.01。关键次要结局的3年事件发生率分别为38.5%和39.7%,风险比为1.01。侵入性治疗组的卒中发生率和死亡或开始透析的发生率均显著高于保守方案组,风险比分别为3.76和1.48。

总之,对于患有稳定型冠脉疾病、晚期慢性肾病以及中度或重度缺血的患者中,没有证据表明与保守方案相比,初始侵入性治疗可降低死亡或非致命性心肌梗塞的风险。

原始出处:

Management of Coronary Disease in Patients with Advanced Kidney Disease.DOI: 10.1056/NEJMoa1915925

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    2020-04-05 MYcat124

    学习了

    0

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    2020-04-05 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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