NEJM:伴有晚期慢性肾脏疾病的稳定性冠状动脉疾病患者应**药物治疗

2020-04-23 MedSci原创 MedSci原创

在稳定的冠状动脉疾病,伴晚期慢性肾脏疾病和中重度缺血患者中,没有证据表明,在药物治疗保守策略基础上,进行侵入性冠状动脉造影和血管重建可降低患者死亡或非致命性心肌梗死风险

目前,评估血管重建对稳定冠状动脉疾病患者疗效的临床试验,常规排除那些晚期慢性肾脏疾病患者。
 
近日,研究招募777名患有晚期肾脏疾病和中度或重度缺血性心脏病患者进行压力测试,患者随机接受侵入性策略治疗,即在药物治疗基础上,进行冠状动脉造影和血管重建或采用保守策略治疗,即单独药物治疗,并且对药物治疗失败者进行血管造影。研究的主要结果是死亡或非致命性心肌梗死。关键的次要结果是死亡、非致命性心肌梗塞、不稳定心绞痛住院、心力衰竭或复苏性心脏骤停。
 
在2.2年的中位随访中,侵入性策略组123例患者和保守策略组129例患者发生了主要结果事件(估计3年事件率,36.4% vs 36.7%;校正危险比:1.01)。组间关键次要结果相似(38.5% vs 39.7%;危险比:1.01)。与保守治疗策略相比,侵袭性治疗策略与卒中死亡(危险比:3.76)和透析风险增加相关(危险比:1.48)。
 
在稳定的冠状动脉疾病,伴晚期慢性肾脏疾病和中重度缺血患者中,没有证据表明,在药物治疗保守策略基础上,进行侵入性冠状动脉造影和血管重建可降低患者死亡或非致命性心肌梗死风险。
 
原始出处:
 
Sripal Bangalore et al. Management of Coronary Disease in Patients with Advanced Kidney Disease. N Engl J Med, April 23, 2020.

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    2020-04-23 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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