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盘点:JACC12月第二期研究一览

2019-12-14 不详 MedSci原创

1. 术者经验与经导管二尖瓣修复术预后呈明显相关DOI: 10.1016/j.jacc.2019.09.014http://www.onlinejacc.org/content/74/24?current-issue=y经导管二尖瓣修复术(TMVr)是一类复杂的治疗二尖瓣反流的手术,本研究的目的旨在评估术者的操作经验与TMVr预后的相关性。本研究纳入分析了2013-2018年数据库中来自290个医


DOI: 10.1016/j.jacc.2019.09.014



经导管二尖瓣修复术(TMVr)是一类复杂的治疗二尖瓣反流的手术,本研究的目的旨在评估术者的操作经验与TMVr预后的相关性。本研究纳入分析了2013-2018年数据库中来自290个医学中心562名术者的14923次TMVr,分析结果发现手术成功率随着术者的操作经验增加而增高(p < 0.001),手术操作时间和并发症发生率降低,这种相关性在调整后的连续变量分析中依旧存在。另外,学习曲线的视觉拐点出现在50例手术后。研究结果显示,对于经导管二尖瓣修复术,操作者的经验与手术的成功率、手术时间和并发症发生率呈明显相关。


DOI: 10.1016/j.jacc.2019.10.019



脂蛋白(a)是一个常见的心血管危险因素,且无已知的治疗策略,低水平的LP(a)与2型糖尿病(T2D)的发生相关。本研究的目的旨在探究LP(a)的摩尔浓度或载脂蛋白(a)的大小与心血管的相关性,以及Lp(a)与T2D风险之间是否存在因果关系。本研究是一个包含143087名冰岛人群的病例对照研究,包括17715名冠心病患者和8734名T2D患者,分析结果发现,LP(a)的摩尔浓度与冠心病、外周动脉疾病、主动脉瓣狭窄、心衰和寿命呈剂量相关性,LP(a)的摩尔浓度可以完全解释冠心病的发生风险,而与载脂蛋白(a)的大小无明显相关性。研究结果显示,脂蛋白(a)的摩尔浓度是心血管疾病的独立危险因素,低水平LP(a)与2型糖尿病的发生相关。


DOI: 10.1016/j.jacc.2019.09.028



三尖瓣反流会增加患者心衰和死亡的风险,经导管三尖瓣介入治疗(TTVI)是一个很有前景的治疗方法,但其益处尚不清楚。本研究的目的旨在评估TTVI的潜在益处。TriValve数据库收集了2016-2018年来自22个医学中心的472名接受TTVI治疗的患者,对照队列由2个大型接受药物治疗的中度及以上三尖瓣反流患者队列组成,并进行倾向性评分配对,主要终点事件是患者1年死亡率、心衰再住院率或两者的复合事件。最终,共纳入分析了268对病例和对照,与对照组相比,接受TTVI治疗的患者1年死亡率更低(23 ± 3% vs. 36 ± 3%; p = 0.001),心衰再住院率更低(26 ± 3% vs. 47 ± 3%; p < 0.0001),复合终点事件率也更低(32 ± 4% vs. 49 ± 3%; p = 0.0003)。另外,TTVI与更高的生存率相关。研究结果显示,与药物治疗相比,经导管三尖瓣介入治疗与更低的死亡率和心衰住院率相关。需要进一步的随机双盲对照试验来确证。


DOI: 10.1016/j.jacc.2019.09.065



非ST段抬高型急性冠脉综合征(NSTEACS)女性患者的不良事件发生率是否高于男性仍不确定,本研究的目的旨在评估NSTEACS患者预后的性别差异。本研究共纳入分析了68730名NSTEACS患者,其中19827名(29%)为女性,相比于男性患者,女性年龄更大,且发生高血压、糖尿病、心衰和肾功能不全的风险更大。在考虑混杂因素之前,女性和男性患者的主要心血管不良事件(MACE)发生率无明显差异([HR]: 1.04; 95% [CI]: 0.99-1.09; p = 0.16),但女性的全因死亡风险更高(HR: 1.12; 95% CI: 1.01-1.24; p = 0.03)。另外,经基线基础特征因素调整分析后发现,MACE和全因死亡风险在女性患者中明显更低。研究结果显示,经心血管危险因素调整分析后,女性NSTEACS患者的不良预后发生率低于男性。然而,女性患者尚未得到充分的治疗。

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    2020-04-22 hbwxf
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    2019-12-15 Dr Z

    学习了

    0

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    2019-12-14 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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