主页 > 医学讨论 >
急性心梗单支病变患者接受PTCA亦能获益
对梗死相关血管进行经皮血管腔内成形术（PTCA），能够改善急性心梗患者的临床转归，目前对此已达成广泛共识，认为可以改善患者左室功能、临床病程等。因此即使心梗后患者没有症状或者心绞痛未复发，也通常接受PTCA，但是没有一项大规模随机研究证实此观点。
基于以上背景，Zeymer等进行了该研究，共纳入300例患者，这些患者都是单支病变的急性心肌梗死患者，在心梗后亚急性期（1～6周）没有或者仅有轻微心绞痛。患者被随机分为PTCA组（149例）和药物治疗组（151例）。主要终点为1年内无再梗、介入或再次介入、冠脉搭桥术生存率或者因严重心绞痛再次入院。
结果显示，药物组和PTCA组患者1年内无事件生存率分别为82%和90%（P=0.06），这一区别主要来自两组间需要介入或再次介入治疗患者人数的差别（20对8，P=0.03）。经过长期随访（平均56个月），药物治疗组和介入治疗组生存率分别为82%和96%（P=0.02）。两组无再梗、介入或再次介入，冠脉搭桥手术生存率分别为66%和80%（P=0.05）。与药物治疗组患者相比，PTCA组患者硝酸酯使用率显著降低，1年时为38%和67%（P=0.001），长期随访结果分别为36%和55%（P=0.006）。
研究者也指出，心梗后低危患者是否应常规进行冠脉介入治疗还需要更大规模研究的证实。
来源：www.genetide.com/ Circulation. 2003 Sep 16;108(11):1324-8.
Randomized comparison of percutaneous transluminal coronary angioplasty and medical therapy in stable survivors of acute myocardial infarction with single vessel disease: a study of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte.
Zeymer U, Uebis R, Vogt A, Glunz HG, Vohringer HF, Harmjanz D, Neuhaus KL; ALKK-Study Group.
Medizinische Klinik II, Klinikum Kassel, Berlin, Germany. Uwe.Zeymer@t-online.de
BACKGROUND: Percutaneous transluminal coronary angioplasty of the infarct-related artery in stable survivors of acute myocardial infarction is often performed, even in patients without any symptoms or residual ischemia. Despite the lack of randomized studies, it is widely believed that this intervention will improve the clinical outcome of these patients. METHODS AND RESULTS: Three hundred patients with single vessel disease of the infarct vessel and no or minor angina pectoris in the subacute phase (1 to 6 weeks) after an acute myocardial infarction were randomized to angioplasty (n=149) or medical therapy (n=151). Primary end point was the survival free of reinfarction, (re)intervention, coronary artery bypass surgery, or readmission for severe angina pectoris at 1 year. The event-free survival at 1 year was 82% in the medical group and 90% in the angioplasty group (P=0.06). This difference was mainly driven by the difference in the need for (re)interventions (20 versus 8, P=0.03). At long-term follow-up (mean, 56 months), survival was 89% and 96% (P=0.02). Survival free of reinfarction, (re)intervention, or coronary artery bypass surgery was 66% and 80% in the medically and interventionally treated patients, respectively (P=0.05). The use of nitrates was significantly lower in the angioplasty group, both at 1 year (38% versus 67%, P=0.001) and at long-term follow-up (36% versus 55%, P=0.006). CONCLUSIONS: Percutaneous revascularization of the infarct-related coronary artery in stable patients with single vessel disease improves clinical outcome at long-term follow-up and reduces the use of nitrates. The results of our study should be reproduced in a confirmatory study with a larger sample size before percutaneous coronary intervention in this low-risk patient subgroup, after myocardial infarction can be recommended as routine treatment in clinical practice.
screen.width-333)this.width=screen.width-333" width=440 height=288 title="Click to view full 11FF1.gif (440 X 288)" border=0 align=absmiddle> [标签:content1][标签:content2]
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-03-28 17:11
医学,生命科学网