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【文摘发布】心肌梗死后持续闭塞的冠脉干预

Title:Coronary Intervention for Persistent Occlusion after Myocardial Infarction

Author:Judith S. Hochman, M.D., Gervasio A. Lamas, M.D., Christopher E. Buller, M.D., Vladimir Dzavik, M.D., Harmony R. Reynolds, M.D., Staci J. Abramsky, M.P.H., Sandra Forman, M.A., Witold Ruzyllo, M.D., Aldo P. Maggioni, M.D., Harvey White, M.D., Zygmunt Sadowski, M.D., Antonio C. Carvalho, M.D., Jamie M. Rankin, M.D., Jean P. Renkin, M.D., P. Gabriel Steg, M.D., Alice M. Mascette, M.D., George Sopko, M.D.,
Matthias E. Pfisterer, M.D., Jonathan Leor, M.D., Viliam Fridrich, M.D., Daniel B. Mark, M.D., M.P.H.,and Genell L. Knatterud, Ph.D., for the Occluded Artery Trial Investigator*
Resource:N Engl J Med 2007;356:998-1008.

Impact Factor:44.016(2005)

Summary:

Background

It is unclear whether stable, high-risk patients with persistent total occlusion of the infarct-related coronary artery identified after the currently accepted period for myocardial salvage has passed should undergo percutaneous coronary intervention (PCI) in addition to receiving optimal medical therapy to reduce the risk of subsequent events.

Methods

We conducted a randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy, and 1084 were assigned to optimal medical therapy alone. The primary end point was a composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure.

Results

The 4-year cumulative primary event rate was 17.2% in the PCI group and 15.6% in the medical therapy group (hazard ratio for death, reinfarction, or heart failure in the PCI group as compared with the medical therapy group, 1.16; 95% confidence interval
[CI], 0.92 to 1.45; P = 0.20). Rates of myocardial reinfarction (fatal and nonfatal) were 7.0% and 5.3% in the two groups, respectively (hazard ratio, 1.36; 95% CI, 0.92 to 2.00; P = 0.13). Rates of nonfatal reinfarction were 6.9% and 5.0%, respectively (hazard ratio, 1.44; 95% CI, 0.96 to 2.16; P = 0.08); only six reinfarctions (0.6%) were related to assigned PCI procedures. Rates of NYHA class IV heart failure (4.4% vs. 4.5%) and death (9.1% vs. 9.4%) were similar. There was no interaction between treatment effect and any subgroup variable (age, sex, race or ethnic group, infarct-related artery, ejection fraction, diabetes, Killip class, and the time from myocardial infarction to randomization).

Conclusions

PCI did not reduce the occurrence of death, reinfarction, or heart failure, and there was a trend toward excess reinfarction during 4 years of follow-up in stable patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction. 本人已认领该文编译,48小时后若未提交译文,请其他战友自由认领。 Title:Coronary Intervention for Persistent Occlusion after Myocardial Infarction
标题:心肌梗死后持续闭塞的冠脉干预
Author:Judith S. Hochman, M.D., Gervasio A. Lamas, M.D., Christopher E. Buller, M.D., Vladimir Dzavik, M.D., Harmony R. Reynolds, M.D., Staci J. Abramsky, M.P.H., Sandra Forman, M.A., Witold Ruzyllo, M.D., Aldo P. Maggioni, M.D., Harvey White, M.D., Zygmunt Sadowski, M.D., Antonio C. Carvalho, M.D., Jamie M. Rankin, M.D., Jean P. Renkin, M.D., P. Gabriel Steg, M.D., Alice M. Mascette, M.D., George Sopko, M.D.,
Matthias E. Pfisterer, M.D., Jonathan Leor, M.D., Viliam Fridrich, M.D., Daniel B. Mark, M.D., M.P.H.,and Genell L. Knatterud, Ph.D., for the Occluded Artery Trial Investigator*
Resource:N Engl J Med 2007;356:998-1008.
出处:新英格兰医学杂志.2007;356:998-1008.
Impact Factor:44.016(2005)
影响因子:44.016(2005)
Summary:
摘要:
Background
背景
It is unclear whether stable, high-risk patients with persistent total occlusion of the infarct-related coronary artery identified after the currently accepted period for myocardial salvage has passed should undergo percutaneous coronary intervention (PCI) in addition to receiving optimal medical therapy to reduce the risk of subsequent events.
对一般公认的心肌抢救期过了之后发现有相关冠状动脉持续梗塞的稳定型高风险患者,除了接受合适的药物治疗外,是否可以通过经皮冠状动脉介入治疗(PCI)来减少后遗症风险还不清楚。
Methods
方法
We conducted a randomized study involving 2166 stable patients who had total occlusion of the infarct-related artery 3 to 28 days after myocardial infarction and who met a high-risk criterion (an ejection fraction of <50% or proximal occlusion). Of these patients, 1082 were assigned to routine PCI and stenting with optimal medical therapy, and 1084 were assigned to optimal medical therapy alone. The primary end point was a composite of death, myocardial reinfarction, or New York Heart Association (NYHA) class IV heart failure.

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作者:admin@医学,生命科学    2011-05-02 05:11
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