Circulation:经皮冠状动脉介入治疗重度主动脉瓣狭窄和冠状动脉疾病

2019-10-23 QQY MedSci原创

对于重度主动脉瓣狭窄和冠状动脉疾病患者,完全经皮进行的主动脉瓣置换术和血管重建术与标准的外科手术方法的优劣,尚无对比数据。前瞻性的SURTAVI试验,于2012年6月-2016年6月期间于多个国家的87个中心招募中等风险的重度主动脉瓣狭窄患者,同时排除复杂冠状动脉疾病SYNTAX评分超过22分的患者。根据是否需要进行血管重建将患者分层,随后将患者随机分至经导管主动脉瓣置换术(TAVR)组或手术主动

对于重度主动脉瓣狭窄和冠状动脉疾病患者,完全经皮进行的主动脉瓣置换术和血管重建术与标准的外科手术方法的优劣,尚无对比数据。

前瞻性的SURTAVI试验,于2012年6月-2016年6月期间于多个国家的87个中心招募中等风险的重度主动脉瓣狭窄患者,同时排除复杂冠状动脉疾病SYNTAX评分超过22分的患者。根据是否需要进行血管重建将患者分层,随后将患者随机分至经导管主动脉瓣置换术(TAVR)组或手术主动脉瓣置换术(SAVR)组。TAVR组冠状动脉重建的患者采用的是行经皮冠状动脉介入治疗,SAVR组患者采用的是冠状动脉旁路搭桥术。主要终点是2年全因死亡率或致残性脑卒中的发生率。

共招募到1660位计划进行主动脉瓣置换的患者,其中332位(20%)需进行血管重建。与不需要进行血管重建的患者相比,需进行血管重建的患者的死亡率更高(4.8±1.7% vs 4.4±1.5%; P<0.01),而且多为男性(65.1% vs 54.2%;P<0.01)。随机分组后,169会患者接受TAVR和经皮冠状动脉介入治疗,163位患者接受SAVR和冠状动脉旁路搭桥,695位患者接受TAVR治疗,633位患者接受SAVR治疗。接受TAVR/经皮冠状动脉介入治疗和SAVR/冠状动脉旁路搭桥治疗的患者的主要终点发生率无明显差异(16.0% vs 14.0%;P=0.62),接受SAVR和TAVR治疗的患者间也无明显差异。

对于重度主动脉瓣狭窄和非复杂冠状动脉疾病患者(SYNTAX评分≤22),完全经皮冠状动脉介入治疗是替代冠状动脉搭桥术的合理选择。

原始出处:

Lars Sondergaard, et al.Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk.Circulation. 2019;140:1296–1305. https://doi.org/10.1161/CIRCULATIONAHA.118.039564

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    2019-10-23 qingfengqishi5

    学习了,学习了

    0

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与一代支架相比,二代药物洗脱支架(DES)用于经皮冠状动脉介入治疗的效果和安全性均更好,部分原因在于其支架更薄。而新一代超薄支架是否能够在二代DES的基础上进一步改善临床预后呢?研究人员在PubMed、Embase和临床试验的Cochrane中心注册处中检索对比新一代超薄DES(支架厚度<70μm)和二代DES的随机临床试验和临床报告。主要结点是随访1年内靶病灶衰竭(包括心血管死亡、靶血管心

TCT 2019:TWILIGHT研究重磅发布,高危PCI患者使用替格瑞洛单药治疗获益显著

支架植入术后的最佳抗血小板治疗方案一直是临床上争议的热点与焦点,如何选择抗血小板药物的种类以及治疗时间都是关乎患者临床预后的重要问题。在2019年美国经导管心血管治疗年会(TCT)上,TWILIGHT研究结果正式公布。

2019 欧洲CTO俱乐部共识文件:慢性完全闭塞经皮再通术

2019年1月,欧洲CTO俱乐部发布了慢性完全闭塞经皮再通术共识,自2006年成立以来欧洲CTO俱乐部努力为最先进的慢性完全闭塞(CTO)经皮冠状动脉介入治疗提供框架。本文主要内容涉及慢性完全闭塞经皮再通术的相关内容。

Eur Heart J:经皮冠状动脉介入治疗前负荷剂量阿托伐他汀对急性冠状动脉综合征患者主要不良心血管事件的短期和长期影响

由此可见,该荟萃分析支持高负荷剂量的阿托伐他汀显著降低ACS患者心血管事件这一概念。

Eur Heart J:癌症患者与经皮冠状动脉介入治疗

由此可见,在接受PCI治疗的患者中癌症较为常见,并且癌症的预后影响对于癌症的类型、有无转移以及当前和既往诊断都是特异性的。对癌症患者的治疗应该个性化,并且需要心脏病专家和肿瘤学家之间的密切合作。