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HEART:两种PCI方法的比较!

2017-11-22 MedSci MedSci原创

近期,一项发表在杂志HEART上的研究旨在评估单次多支血管经皮冠状动脉介入治疗(PCI)的方法相对于分期多支血管的治疗对稳定性冠心病(CAD)或非ST段抬高急性冠脉综合征患者临床预后的影响。此项研究在京都PCI /冠状动脉旁路移植注册研究队列-2的冠状动脉再血管化结局研究中进行,共有2018名患者接受了选择性多支血管PCI治疗。主要终点指标为5年随访期间全因死亡、心肌梗死和卒中情况。最终,共有70

近期,一项发表在杂志HEART上的研究旨在评估单次多支血管经皮冠状动脉介入治疗(PCI)的方法相对于分期多支血管的治疗对稳定性冠心病(CAD)或非ST段抬高急性冠脉综合征患者临床预后的影响。


此项研究在京都PCI /冠状动脉旁路移植注册研究队列-2的冠状动脉再血管化结局研究中进行,共有2018名患者接受了选择性多支血管PCI治疗。主要终点指标为5年随访期间全因死亡、心肌梗死卒中情况。

最终,共有707例(35.0%)和1311例(65.0%)患者分别进行了单次多支PCI和分期多支PCI治疗。主要终点指标的累积5年发病率和调整后风险在单次和分期组间没有显着差异(26.7%vs 23.0%,p = 0.45;HR 0.91,95%CI 0.72-1.16,p = 0.47)。

单次治疗组的全因死亡发生率显着高于分期组(1.1% vs. 0.2%,p = 0.009)。然而,30天内死亡的11例患者的死亡原因与手术并发症无关,而与PCI术前患者严重的临床状况有关。对于包括年龄、性别、CAD范围、严重慢性肾病和心力衰竭在内的亚组分析显示,亚组因素与单次治疗策略相对于主要治疗的分期策略之间没有显着的相互作用。

此项研究结果表明:尽管目前的研究中采用单次治疗的方法较低,但与分期多支血管病变PCI相比,单次治疗的多支血管病变PCI策略的5年临床结果具有可比性。

原始出处:
Toyota T, Morimoto T, et al. Single-session versus staged procedures for elective multivessel percutaneous coronary intervention. Heart. 2017 Nov 16. pii: heartjnl-2017-312117. doi: 10.1136/heartjnl-2017-312117. 

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    2017-11-24 zhaojie88
  2. [GetPortalCommentsPageByObjectIdResponse(id=1356579, encodeId=101a13565e93a, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Fri Nov 24 10:17:00 CST 2017, time=2017-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562750, encodeId=25a41562e5063, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Fri Nov 24 10:17:00 CST 2017, time=2017-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=263729, encodeId=b1dc263e297f, content=好资料学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=92191944782, createdName=thlabcde, createdTime=Thu Nov 23 22:05:25 CST 2017, time=2017-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=263622, encodeId=994026362207, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo4cyIbibqa2VuNGCKeyRxITYNqLTIaoFo3Jx2LSawp8yrFSs1CIXKv1jyXV97ecnxhhktGKkPP9onfJFZCbiayLgic/0, createdBy=3f1c1956638, createdName=1e127dd4m40(暂无匿称), createdTime=Thu Nov 23 13:32:35 CST 2017, time=2017-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=263432, encodeId=a0cd2634323c, content=近期.一项发表在杂志HEART上的研究旨在评估单次多支血管经皮冠状动脉介入治疗(PCI)的方法相对于分期多支血管的治疗对稳定性冠心病(CAD)或非ST段抬高急性冠脉综合征患者临床预后的影响., beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Wed Nov 22 21:36:22 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
    2017-11-24 slcumt
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    2017-11-23 thlabcde

    好资料学习了!

    0

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    2017-11-23 1e127dd4m40(暂无匿称)

    学习了

    0

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    2017-11-22 有备才能无患

    近期.一项发表在杂志HEART上的研究旨在评估单次多支血管经皮冠状动脉介入治疗(PCI)的方法相对于分期多支血管的治疗对稳定性冠心病(CAD)或非ST段抬高急性冠脉综合征患者临床预后的影响.

    0

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在吸烟者中,双倍剂量氯吡格雷减少了经皮冠状动脉介入治疗后主要心血管事件和支架血栓形成,并且没有增加大出血风险。这表明急性冠脉综合征患者服用氯吡格雷剂量应该个性化,同时应考虑到缺血和出血的风险。

病例分享:艰难的抉择:复杂病例简单处理一例

临床实践中,我们经常会面临很多复杂患者。该病例的诊治过程可谓“山重水尽疑无路,柳暗花明又一村”。

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