Heart:常规侵入治疗对老年NSTEACS患者的临床结局有何影响?

2017-12-28 安雅晶 环球医学

2017年12月,发表在《Heart》上的一项研究,考察了常规侵入治疗对老年非ST段抬高型的急性冠脉综合征(NSTEACS)患者不良结局的影响。

2017年12月,发表在《Heart》上的一项研究,考察了常规侵入治疗对老年非ST段抬高型的急性冠脉综合征(NSTEACS)患者不良结局的影响。

目的:在老年NSTEACS人群中,血运重建是否优于药物治疗仍存在争议,随机试验尚无确定证据。研究人员旨在老年NSTEACS患者中比较常规侵入治疗和初始药物治疗。

方法:在MEDLINE、EMBASE和Cochrane对照试验数据库检索:比较常规侵入治疗和初始药物治疗用于NSTEACS≥75岁患者的研究。终点包括长期死亡率、心肌梗塞(MI)、血运重建、再住院率、卒中和以ORs报道的主要出血。

结果:4项随机试验和3项观察性研究符合纳入标准,共纳入20540名患者,随访6个月至5年。常规侵入治疗能降低死亡率(OR 0.67,CI 0.61~0.74)、MI(OR 0.56,CI 0.45~0.70)和卒中(OR 0.53,CI 0.30~0.95)。限制于随机对照试验(RCTs)的分析证实:MI(OR 0.51,CI 0.40~0.66)和血运重建(OR 0.27,CI 0.13~0.56)有所降低,且死亡率也有降低趋势(OR 0.84,CI 0.66~1.06),然而大出血风险增加(OR 2.19,CI 1.12~4.28)。大出血的差异在最近的研究中是不显着的。

结论:常规侵入治疗能减少老年NSTEACS患者的心肌梗塞、再次血运重建和降低死亡率,但以大出血为代价。研究人员的结果强调,需要进一步的RCTs来更好地确认对死亡率和当代出血风险的影响。

原始出处:
Gnanenthiran SR, Kritharides L, D'Souza M,et al.Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis.Heart. 2017 Dec;103(24):1962-1969. doi: 10.1136/heartjnl-2017-311233. Epub 2017 Jun 16.

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    2018-05-18 drj2003
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    2018-01-02 大爰

    学习了谢谢分享!!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1977542, encodeId=acf119e754234, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Fri May 18 10:44:00 CST 2018, time=2018-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935417, encodeId=9e54193541e0e, content=<a href='/topic/show?id=db231e242d1' target=_blank style='color:#2F92EE;'>#TEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17242, encryptionId=db231e242d1, topicName=TEA)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83erCiat0j36p5MejdM9yCLtcVcY8WS5VIKuCMqXFNs56U6iacZib5CJvh6mVxGERicM6ZAkl91jMgpcDrw/132, createdBy=37622500012, createdName=ms2999106592497887, createdTime=Sun Feb 25 22:44:00 CST 2018, time=2018-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843137, encodeId=7e51184313e44, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Thu Sep 20 22:44:00 CST 2018, time=2018-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274703, encodeId=62a62e470347, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Tue Jan 02 09:40:26 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279220, encodeId=9bbc12e9220e9, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356622, encodeId=b234135662280, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562779, encodeId=87f81562e7951, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, 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=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574985, encodeId=815715e4985db, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2017-12-30 yaanren
  6. [GetPortalCommentsPageByObjectIdResponse(id=1977542, encodeId=acf119e754234, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Fri May 18 10:44:00 CST 2018, time=2018-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1935417, encodeId=9e54193541e0e, content=<a href='/topic/show?id=db231e242d1' target=_blank style='color:#2F92EE;'>#TEA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17242, encryptionId=db231e242d1, topicName=TEA)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83erCiat0j36p5MejdM9yCLtcVcY8WS5VIKuCMqXFNs56U6iacZib5CJvh6mVxGERicM6ZAkl91jMgpcDrw/132, createdBy=37622500012, createdName=ms2999106592497887, createdTime=Sun Feb 25 22:44:00 CST 2018, time=2018-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1843137, encodeId=7e51184313e44, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Thu Sep 20 22:44:00 CST 2018, time=2018-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=274703, encodeId=62a62e470347, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Tue Jan 02 09:40:26 CST 2018, time=2018-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1279220, encodeId=9bbc12e9220e9, content=<a href='/topic/show?id=316d1882bc' target=_blank style='color:#2F92EE;'>#ACS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1882, encryptionId=316d1882bc, topicName=ACS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=102a153, createdName=yaanren, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356622, encodeId=b234135662280, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562779, encodeId=87f81562e7951, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, 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=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574985, encodeId=815715e4985db, content=<a href='/topic/show?id=52ab188e48' target=_blank style='color:#2F92EE;'>#ACS患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1887, encryptionId=52ab188e48, topicName=ACS患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf9f16042984, createdName=neurosurgeon, createdTime=Sat Dec 30 07:44:00 CST 2017, time=2017-12-30, status=1, ipAttribution=)]
    2017-12-30 爆笑小医
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    2017-12-30 slcumt
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