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【medical-news】最佳内科治疗联合或不联合经皮冠
标题:Optimal Medical Therapy with or without PCI for Stable Coronary Disease
最佳内科治疗联合或不联合经皮冠状动脉介入(PCI)治疗稳定性冠心病的比较
作者:William E. Boden, M.D., Robert A. O'Rourke, M.D., Koon K. Teo, M.B., B.Ch., Ph.D., Pamela M. Hartigan, Ph.D., David J. Maron, M.D., William J. Kostuk, M.D., Merril Knudtson, M.D., Marcin Dada, M.D., Paul Casperson, Ph.D., Crystal L. Harris, Pharm.D., Bernard R. Chaitman, M.D., Leslee Shaw, Ph.D., Gilbert Gosselin, M.D., Shah Nawaz, M.D., Lawrence M. Title, M.D., Gerald Gau, M.D., Alvin S. Blaustein, M.D., David C. Booth, M.D., Eric R. Bates, M.D., John A. Spertus, M.D., M.P.H., Daniel S. Berman, M.D., G.B. John Mancini, M.D., William S. Weintraub, M.D., for the COURAGE Trial Research Group
ABSTRACT
摘要：
Background：In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.
背景：对于稳定性冠心病来说，皮冠状动脉介入(PCI)联合强化药物治疗及生活方式干预（最优内科治疗）的初始的管理策略对减少心血管事件风险是否优于单独最优内科治疗，这点仍不清楚。
Methods :We conducted a randomized trial involving 2287 patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U.S. and Canadian centers. Between 1999 and 2004, we assigned 1149 patients to undergo PCI with optimal medical therapy (PCI group) and 1138 to receive optimal medical therapy alone (medical-therapy group). The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2.5 to 7.0 years (median, 4.6).
方法：随机试验中来自美国和加拿大50个中心的2287例患者，均有心肌缺血和明显冠心病的客观证据。1999年至2004年，1149例患者接受PCI联合最优内科治疗（PCI组），1138例患者接受单独最优内科治疗（内科治疗组）。主要结果是在随访2.5至7年期间发生的任何原因导致的死亡、非致死性心肌梗死。
Results :There were 211 primary events in the PCI group and 202 events in the medical-therapy group. The 4.6-year cumulative primary-event rates were 19.0% in the PCI group and 18.5% in the medical-therapy group (hazard ratio for the PCI group, 1.05; 95% confidence interval [CI], 0.87 to 1.27; P=0.62). There were no significant differences between the PCI group and the medical-therapy group in the composite of death, myocardial infarction, and stroke (20.0% vs. 19.5%; hazard ratio, 1.05; 95% CI, 0.87 to 1.27; P=0.62); hospitalization for acute coronary syndrome (12.4% vs. 11.8%; hazard ratio, 1.07; 95% CI, 0.84 to 1.37; P=0.56); or myocardial infarction (13.2% vs. 12.3%; hazard ratio, 1.13; 95% CI, 0.89 to 1.43; P=0.33).
结果：PCI组有 211例主要事件，内科治疗组有 202事件。4.6年累积主要事件率PCI组为19.0% 、内科治疗组为 18.5% (PCI组风险比 1.05; 95% 可信区间[CI], 0.87 - 1.27; P=0.62). 两组间所有死亡数、心肌梗死、脑血管意外无显著差别(20.0% 比19.5%;风险比1.05; 95% CI, 0.87-1.27; P=0.62);因急性冠脉综合症住院人数(12.4% 比 11.8%; 风险比1.07; 95% CI, 0.84 - 1.37; P=0.56); 或心肌梗死 人数(13.2% 比12.3%;风险比 1.13; 95% CI, 0.89 - 1.43; P=0.33).
Conclusions: As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy
结论：作为稳定性冠心病患者的初始管理策略，PCI联合最优内科治疗不能降低死亡、心肌梗死或其他主要心血管事件风险。
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作者:admin@医学,生命科学 2011-07-14 17:13
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