Lancet:老年非ST段抬高型心肌梗死或不稳定型心绞痛患者:介入治疗优于保守治疗

2016-01-13 崔倩 译 MedSci原创

非ST段抬高心肌梗死(NSTEMI)和不稳定心绞痛是在老年人入院的常见原因。然而,针对这部分人群的临床试验是稀缺的,而这些病人不太可能按照指南接受治疗。该研究的目的是调查这个人群是否会受益于早期介入治疗 vs 保守策略。原始出处:Nicolai Tegn, Michael Abdelnoor,Lars Aaberge,et al.Invasive versus conservative strat

非ST段抬高型心肌梗死(NSTEMI)和不稳定型心绞痛是老年人入院治疗的常见原因。然而,针对这部分人群的临床研究是稀缺的,而这些病人不太可能按照指南接受治疗。该研究的目的是调查这个人群早期介入治疗 vs 保守策略是否会受益。

在这个开放性的随机对照、多中心试验中,挪威东南健康区16家医院的80岁以上的NSTEMI或不稳定型心绞痛老年患者,被随机分配接受介入治疗(包括早期经皮冠状动脉介入治疗,冠状动脉旁路移植术,和最佳的医学治疗——冠状动脉造影即时评估),或保守策略(最佳的单独医疗治疗)。随机置换块是由生物统计学和流行病学中心产生的。主要成果是心肌梗死、需要紧急血运重建、卒中、死亡,在2010年12月10日和2014年11月18日之间进行评估。采用意向性治疗进行分析。

在平均随访1.53年中,参与者是在2010年12月10日和2014年2月21日之间招募进来的,介入治疗组的229例患者中有93例患者(40.6%)发生主要终点,而保守治疗组的228例患者中有140例患者发生主要终点(危险比(HR)0.53[95%Cl 0.41-0.69],p=0.000)。介入治疗组有5例患者退出治疗,保守治疗组有1例患者退出。针对主要复合终点的四个组成部分的HRs分别为心肌梗死0.52(0.35-0.76,P=0.0010),需要紧急血运重建0.19(0.07-0.52,P=0.0010 ),中风0.60(0.25-1.46,P=0.2650),任何原因引起的死亡为0.89(0.62-1.28,P=0.5340)。介入治疗组有4例患者(1.7%)和23例患者(10.0%)分别发生主要和轻微出血的并发症,而保守治疗组分别有4例患者(1.8%)和16例患者(7.0%)发生主要和轻微出血并发症。

在80岁以上有NSTEMI或不稳定型心绞痛的患者中,在减少复合事件的发生方面,介入治疗优于保守治疗。介入治疗的功效随着年龄的增加而减小(调整了肌酐和效果修改后)。这两种策略在出血并发症方面并没有差异。

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content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), 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  5. [GetPortalCommentsPageByObjectIdResponse(id=1967250, encodeId=47fd196e25012, content=<a href='/topic/show?id=0973992313a' target=_blank style='color:#2F92EE;'>#非ST段抬高型心肌梗死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99231, encryptionId=0973992313a, topicName=非ST段抬高型心肌梗死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac59108, createdName=hxj0117, createdTime=Sun Jun 19 16:07:00 CST 2016, time=2016-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1981736, encodeId=be261981e36f5, content=<a href='/topic/show?id=e398204493e' target=_blank style='color:#2F92EE;'>#不稳定型心绞痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20449, encryptionId=e398204493e, topicName=不稳定型心绞痛)], attachment=null, authenticateStatus=null, createdAvatar=, 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content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508901, encodeId=01cc150890160, content=<a href='/topic/show?id=8e1e2e181f4' target=_blank style='color:#2F92EE;'>#保守治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27181, encryptionId=8e1e2e181f4, topicName=保守治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9d710016703, createdName=cmsvly, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=)]
  6. 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topicList=[TopicDto(id=75289, encryptionId=8b44e528972, topicName=稳定型)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18b32500069, createdName=108807375_62823127, createdTime=Fri Aug 05 08:07:00 CST 2016, time=2016-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1926980, encodeId=cf00192698062, content=<a href='/topic/show?id=be549922826' target=_blank style='color:#2F92EE;'>#非ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99228, encryptionId=be549922826, topicName=非ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ed3112, createdName=echonoir, createdTime=Thu May 26 13:07:00 CST 2016, time=2016-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828379, encodeId=80c418283e927, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Jan 27 19:07:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819095, encodeId=4a25181909555, content=<a href='/topic/show?id=de2d99226e2' target=_blank style='color:#2F92EE;'>#非ST段#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99226, encryptionId=de2d99226e2, topicName=非ST段)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Sun Jun 05 04:07:00 CST 2016, time=2016-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58783, encodeId=f96b58e8352, content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508901, encodeId=01cc150890160, content=<a href='/topic/show?id=8e1e2e181f4' target=_blank style='color:#2F92EE;'>#保守治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27181, encryptionId=8e1e2e181f4, topicName=保守治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9d710016703, createdName=cmsvly, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=)]
    2016-01-27 howi
  7. 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content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508901, encodeId=01cc150890160, content=<a href='/topic/show?id=8e1e2e181f4' target=_blank style='color:#2F92EE;'>#保守治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27181, encryptionId=8e1e2e181f4, topicName=保守治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9d710016703, createdName=cmsvly, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=)]
    2016-06-05 lxg951
  8. 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content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508901, encodeId=01cc150890160, content=<a href='/topic/show?id=8e1e2e181f4' target=_blank style='color:#2F92EE;'>#保守治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27181, encryptionId=8e1e2e181f4, topicName=保守治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9d710016703, createdName=cmsvly, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=)]
    2016-01-22 惜言

    不错!

    0

  9. 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content=不错!, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150830/IMG55E294026A9942981.jpg, createdBy=fa351627501, createdName=惜言, createdTime=Fri Jan 22 13:20:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423010, encodeId=0bdd1423010c8, content=<a href='/topic/show?id=936c16863b5' target=_blank style='color:#2F92EE;'>#ST段抬高#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16863, encryptionId=936c16863b5, topicName=ST段抬高)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=91d33758978, createdName=gdsun, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508901, encodeId=01cc150890160, content=<a href='/topic/show?id=8e1e2e181f4' target=_blank style='color:#2F92EE;'>#保守治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27181, encryptionId=8e1e2e181f4, topicName=保守治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d9d710016703, createdName=cmsvly, createdTime=Thu Jan 14 23:07:00 CST 2016, time=2016-01-14, status=1, ipAttribution=)]
    2016-01-14 gdsun
  10. 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蛋白质,老年骨质疏松症患者的“爱”还是“害”?

随着科学研究的深入,越来越多的证据表明:膳食营养因素在骨质疏松症预防治疗中的作用至关重要。许多营养素例如钙、维生素D等均在骨质疏松症的防治中扮演重要角色,为广大患者所熟知,但仍有某些营养素尚存争议,蛋白质便是其中之一。 作为三大产热营养素之一,蛋白质对于机体的重要生理作用毋庸置疑。然而长久以来,在骨质疏松症的防治中,针对蛋白质作用的研究结论并不一致:一方面,蛋白质是构成骨骼的基础原料,长期缺

J Nucl Med:基于神经连接网络**预测老年性神经退行性疾病

判断是否患有老年痴呆症需要经过哪些程序?做认知度的调查问卷、抽血检验、脑部核磁共振……,然后医生在这些资料的基础上凭经验判断患者是否得了老年痴呆症。不过,以后检查这样的疾病就不用那么恼火啦! 33岁的牛人教授,把大数据和神经科学结合在一起,仅凭一张大脑的核磁共振图像,就能辅助医生,提前预测出老年痴呆症。主要技术是个体结构连接网络(individual structural connectivit

Addict Biol:老年人饮酒过多,增加死亡率

研究者设计了这项队列研究确定是否过度饮酒会增加死亡的风险,受试者为年龄70-89的男性。研究者报道了2001-2004年受试者的饮酒史(从不,过去,每天小于2两,每天2-4两,每天4-6两,每天超过6两),并采集受试者血样。研究者确定ADH1B rs1229984中G>A多态性并且从西部澳大利亚数据联动系统提取死亡率的数据。其他研究措施包括年龄,教育,BMI,吸烟史,高血压,糖尿病,慢性呼吸

这个年龄段男性性行为健康调查结果令人震惊!

一项对60-84岁的美国男性进行调查的新研究发表在 the American Journal of Men's Health上,研究结果表明:年龄越大,性行为越频繁,在商业性服务里体验无保护性行为的可能性就越大。作者Christine Milrod说:“目前普遍认为老年人不会花钱找性服务或者不会有规律的性行为。这种观点可能会给客户和性工作者带来错误的安全感,可能会导致更少的保护措施(与花钱体验性服