Coronary revascularization

冠状动脉血运重建
  • 文章类型: Journal Article
    患有糖尿病(DM)的患者在经皮冠状动脉介入治疗后的结果比非糖尿病患者差。新型SupremeDES是一种可生物降解的聚合物西罗莫司洗脱支架,旨在同步早期药物输送,限制长期炎症反应的可能性。这项研究的目的是评估SupremeDES在DM患者中的安全性和有效性。
    这是来自PIONEERIII随机(2:1)的糖尿病亚组的预设分析,对照试验,比较SupremeDES与耐用的聚合物依维莫司洗脱支架(DP-EES)。主要的安全性和有效性复合终点是1年的目标病变失败,心脏死亡的复合物,靶血管心肌梗死,或临床驱动的靶病变血运重建。
    PIONEERIII试验将1629名患者随机分组,其中494例(30.3%)患有DM,331例(398个病灶)被随机分配至SupremeDES,163例(208个病灶)被随机分配至DP-EES.在DM患者中,SupremeDES治疗1年目标病变失败为6.1%(20/331),DP-EES治疗为3.7%(6/163)(风险比=1.65;95%置信区间=0.66-4.10,P=.28).最高DES和DP-EES的心源性死亡或靶血管心肌梗死的复合率为3.3%(11/331),DP-EES的复合率为3.7%(6/163)(风险比=0.90;95%置信区间=0.33-2.44,P=.83)。其他次要终点无显著差异。
    这项PIONEERIII试验的预设子研究证明了新型SupremeDES在1年糖尿病患者中与市售DP-EES相比的相对安全性和有效性。需要长期随访以确保SupremeDES的持续安全性和有效性。
    UNASSIGNED: Patients with diabetes mellitus (DM) have worse outcomes following percutaneous coronary intervention than nondiabetic patients. The novel Supreme DES is a biodegradable polymer sirolimus-eluting stent designed to synchronize early drug delivery, limiting the potential for long-term inflammatory response. The purpose of this study was to evaluate the safety and efficacy of the Supreme DES in patients with DM.
    UNASSIGNED: This is a prespecified analysis of the diabetic subgroup from the PIONEER III randomized (2:1), controlled trial, comparing the Supreme DES with a durable polymer everolimus-eluting stent (DP-EES). The primary safety and efficacy composite endpoint was target lesion failure at 1 year, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization.
    UNASSIGNED: The PIONEER III trial randomized 1629 patients, of which 494 (30.3%) had DM with 331 (398 lesions) randomly assigned to Supreme DES and 163 (208 lesions) to DP-EES. Among patients with DM, target lesion failure at 1 year was 6.1% (20/331) with Supreme DES vs 3.7% (6/163) with DP-EES (hazard ratio = 1.65; 95% confidence interval = 0.66-4.10, P = .28). The composite of cardiac death or target vessel myocardial infarction was 3.3% (11/331) with Supreme DES and 3.7% (6/163) with DP-EES (hazard ratio = 0.90; 95% confidence interval = 0.33-2.44, P = .83). There were no significant differences in other secondary endpoints.
    UNASSIGNED: This prespecified substudy of the PIONEER III trial demonstrated the relative safety and efficacy of the novel Supreme DES when compared with commercially available DP-EES in diabetics at 1 year. Longer term follow-up will be required to ensure continued safety and efficacy of the Supreme DES.
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  • 文章类型: Journal Article
    神经认知功能障碍在心力衰竭(HF)中很常见,30%到80%的患者在一个或多个认知领域出现一定程度的缺陷,包括记忆,注意,学习能力,执行功能,和精神运动速度。尽管机制尚未完全了解,心输出量减少,合并症,慢性脑低灌注,心脏栓塞性脑损伤导致脑缺氧和脑损伤似乎会引发HF的神经认知功能障碍。认知障碍与包括死亡率在内的较差预后独立相关,再住院,降低了生活质量。认知功能较差的患者患严重疾病的风险增加,因为他们往往很难满足治疗要求。缺血性HF患者的冠状动脉血运重建有可能改善心血管预后,但有进一步恶化神经认知功能障碍的风险。冠状动脉旁路移植术的血运重建具有谵妄的固有风险,认知障碍,神经损伤,和中风,已知会加剧神经认知功能障碍的风险。或者,经皮冠状动脉介入治疗,作为一种侵入性较小的方法,有可能将认知障碍的风险降至最低,但尚未评估为缺血性HF患者冠状动脉旁路移植术的替代方法。因此,最重要的是提高对缺血性HF的神经认知后果的认识,并制定识别和预防策略,作为患者管理和个性化决策的重要目标,有助于患者预后.
    Neurocognitive dysfunction is common in heart failure (HF), with 30% to 80% of patients experiencing some degree of deficits in one or more cognitive domains, including memory, attention, learning ability, executive function, and psychomotor speed. Although the mechanism is not fully understood, reduced cardiac output, comorbidities, chronic cerebral hypoperfusion, and cardioembolic brain injury leading to cerebral hypoxia and brain damage seem to trigger the neurocognitive dysfunction in HF. Cognitive impairment is independently associated with worse outcomes including mortality, rehospitalization, and reduced quality of life. Patients with poorer cognitive function are at an increased risk of severe disease as they tend to have greater difficulty complying with treatment requirements. Coronary revascularization in patients with ischemic HF has the potential to improve cardiovascular outcomes but risks worsening neurocognitive dysfunction even further. Revascularization by coronary artery bypass grafting carries inherent risks for delirium, cognitive impairment, neurologic injury, and stroke, which are known to exacerbate the risk of neurocognitive dysfunction. Alternatively, percutaneous coronary intervention, as a less-invasive approach, has the potential to minimize the risk of cognitive impairment but has not yet been evaluated as an alternative to coronary artery bypass grafting in patients with ischemic HF. Therefore, it is paramount to raise awareness of the neurocognitive consequences in ischemic HF and devise strategies for recognition and prevention as an important target of patient management and personalized decision making that contributes to patient outcomes.
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  • 文章类型: Journal Article
    Supreme愈合靶向药物洗脱支架(DES)旨在促进内皮愈合,以减少与支架相关的不良事件。这在具有较高不良事件发生率的复杂病变中可能特别相关。我们试图比较SupremeDES和当代耐久聚合物在复杂病变中经皮冠状动脉介入治疗的1年结局。依维莫司洗脱支架(DP-EES)。
    PIONEERIII是一个多中心,prospective,单盲临床试验,将1629例急性或慢性冠脉综合征患者以2:1的比例随机分配给SupremeDES或DP-EES。在1137例患者中发现了复杂的病变(美国心脏病学会/美国心脏协会B2/C型)。结果也比较了病变复杂性的具体参数:严重钙化,长(>20毫米),和严重的弯曲。主要终点是1年的靶病变失败。
    在1年,SupremeDES和DP-EES在靶病变失败方面无差异:(5.7%vs5.6%;风险比1.00,95%置信区间0.59-1.68,P=.99).同样,病变成功的次要终点无差异(99.7%vs99.4%,P=.41),设备成功(97.0%vs98.5%,P=.14),目标血管故障(6.5%对7.4%,P=.50),主要不良心脏事件(7.8%vs8.5%,P=.64),或支架血栓形成(0.7%vs1.1%,P=.48)。使用SupremeDES观察到靶病变血运重建率更高的趋势(2.5%vs0.9%,P=.06)。
    这项研究表明,与标准DP-EES相比,SupremeDES在1年时在广泛的病变复杂性中同样有效和安全。
    UNASSIGNED: The Supreme healing-targeted drug-eluting stent (DES) is designed to promote endothelial healing to reduce stent-related adverse events. This may be particularly relevant among complex lesions that have a higher rate of adverse events. We sought to compare 1-year outcomes of percutaneous coronary intervention in complex lesions between the Supreme DES and contemporary durable-polymer, everolimus-eluting stents (DP-EES).
    UNASSIGNED: PIONEER III was a multicenter, prospective, single-blind clinical trial, randomizing 1629 patients with either an acute or chronic coronary syndrome in a 2:1 ratio to the Supreme DES or DP-EES. Complex lesions (American College of Cardiology/American Heart Association type B2/C) were found in 1137 patients. Outcomes were also compared for specific parameters of lesion complexity: severe calcification, long length (>20 ​mm), and severe tortuosity. The primary end point was target lesion failure at 1 ​year.
    UNASSIGNED: At 1 ​year, there was no difference in target lesion failure between the Supreme DES and DP-EES: (5.7% vs 5.6%; hazard ratio 1.00, 95% confidence interval 0.59-1.68, P = .99). Similarly, there were no differences in the secondary end points of lesion success (99.7% vs 99.4%, P = .41), device success (97.0% vs 98.5%, P = .14), target vessel failure (6.5% vs 7.4%, P = .50), major adverse cardiac events (7.8% vs 8.5%, P = .64), or stent thrombosis (0.7% vs 1.1%, P = .48). A trend was observed toward a higher rate of target lesion revascularization with the Supreme DES (2.5% vs 0.9%, P = .06).
    UNASSIGNED: This study suggests that the Supreme DES is as effective and safe at 1 ​year compared with the standard DP-EES across a broad spectrum of lesion complexity.
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  • 文章类型: Journal Article
    急性心肌梗死(AMI)并发心律失常的患者并不少见。在急性心肌梗死(AMI)期间心律失常患者中插入临时起搏器(tPM)是必要的支持治疗。心律失常包括高度房室传导阻滞(AVB),窦性停搏/心动过缓,室性心律失常风暴。迄今为止,尚无研究评估AMI并发心律失常患者tPMs的预后。特别是在溶栓或急诊经皮冠状动脉介入治疗(PCI)冠状动脉血运重建的时代,本研究旨在探讨在AMI并发各种心律失常病例中植入tPMs的价值。
    从2009年1月到2019年1月,35,394例AMI患者,包括4家医院的62.0%(21,935)的ST段抬高型心肌梗死(STEMI)和38.0%(13,459)的非ST段抬高型心肌梗死(NSTEMI),被审查了。共有552名AMI患者与心律失常相关。在552名患者中,有139例患者进行了tPM插入。分析近10年心肌梗死并发各种心律失常的发病趋势,和临床特征,住院死亡率,出院后死亡率,模态的复合端点,在冠状动脉血运重建时代,比较有和无tPM的患者的独立危险因素。
    在AMI相关心律失常患者中,高度AVB是tPM插入的主要原因(p=0.045)。在过去的10年里,高度AVB患者的数量,tPM植入,室性心律失常风暴,在冠状动脉血运重建时代,院内死亡率逐年下降。在tPM组中,罪魁祸首血管是左主动脉,和心源性休克,急性肾损伤和高脑钠肽(BNP)水平是AMI并发心律失常的独立危险因素。tPM组的住院死亡率高于非tPM组。与未插入tPM的患者相比,插入tPM的患者显示出更好的出院后生存率。
    在急诊溶栓或PCI时代,冠状动脉血运重建可以改善AMI并发各种心律失常患者的预后。AMI合并心律失常患者临时置入起搏器可降低出院后病死率。
    UNASSIGNED: Patients with acute myocardial infarction (AMI) complicated with arrhythmia are not uncommon. Insertion of temporary pacemakers (tPMs) in patients with arrythmia during acute myocardial infarction (AMI) is imperative support therapy. Arrhythmias include high-degree atrioventricular block (AVB), sinus arrest/bradycardia, and ventricular arrythmia storm. To date, no study has evaluated the prognosis of tPMs in patients with AMI complicated with arrhythmia. Especially in the era of thrombolysis or emergency percutaneous coronary intervention (PCI) for coronary artery revascularization, our study was designed to investigate the value of tPMs implantation in cases of AMI complicated with various arrhythmias.
    UNASSIGNED: From January 2009 to January 2019, 35,394 patients with AMI, including 62.0% (21,935) with ST-segment elevation myocardial infarction (STEMI) and 38.0% (13,459) with non-ST-segment elevation myocardial infarction (NSTEMI) in four hospitals, were reviewed. A total of 552 patients with AMI associated with arrythmia were included in the cohort. Among the 552 patients, there were 139 patients with tPM insertions. The incidence trend of myocardial infarction complicated with various arrhythmias in the past 10 years was analysed, and the clinical characteristics, in-hospital mortality, postdischarge mortality, composite endpoints of modality, and independent risk factors were compared in patients with and without tPM in the era of coronary artery revascularization.
    UNASSIGNED: In patients with AMI-associated arrythmia, high-degree AVB was the major cause of tPM insertion (p = 0.045). In the past 10 years, the number of patients with high-degree AVB, tPM implantation, ventricular arrythmia storm, and in-hospital mortality has decreased year by year in the era of coronary artery revascularization. In the tPM group, the culprit vessel was the left main artery, and cardiogenic shock, acute renal injury and high brain natriuretic peptide (BNP) levels were independent risk factors for patients with AMI complicated with arrhythmia. The in-hospital mortality in the tPM group was higher than that in the non-tPM group. The patients with tPM insertion showed better postdischarge survival than patients without tPM insertion.
    UNASSIGNED: In the era of emergency thrombolysis or PCI, coronary revascularization can ameliorate the prognosis of patients with AMI complicated with various arrhythmias. Temporary pacemaker insertion in patients with AMI complicated with arrhythmia can reduce the postdischarge mortality of these patients.
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  • 文章类型: Journal Article
    最近,关于血流储备分数(FFR)的疗效和有效性的问题在各种临床环境中都出现了.
    FFR指导的冠状动脉病变血运重建策略(HALE-BOPP)研究的临床结果是研究者发起的,多中心,国际前瞻性研究纳入对至少一条血管进行FFR测量的患者。按照决策工作流程和处理,血管分为三个亚组:(i)血管再血管化,(ii)FFR血运重建,(iii)FFR-递延。主要终点是目标血管衰竭的发生(TVF,心脏死亡,靶血管心肌梗死和缺血驱动的靶血管血运重建)。在血管和患者水平进行分析。
    1305名患有2422条病变血管的患者符合本分析的标准。电线相关的陷阱和一过性腺苷相关的副作用发生在0.8%(95%CI:0.4%-1.4%)和3.3%(95%CI:2.5%-4.3%)的病例中,分别。在FFR延迟的船只中,TVF的总发生率为0.024(95%CI:0.019-0.031)病变/年.经过3.6年的中位随访,TVF的发生率为6%,7%和11.7%的FFR递延,FFR血管重建和血管血管重建血管,分别。与血管重建血管相比,FFR引导的血管(FFR血运重建和FFR延迟血管)显示TVF病变/年发生率较低(0.029,95%CI:0.024-0.034vs.0.049,95%CI:分别为0.040-0.061,p=0.0001)。校正混杂因素和临床感兴趣的亚组后,结果是一致的。患者水平分析证实,在FFR阴性患者中,TVF的发生率较低。FFR阳性亚组。
    在一项大型前瞻性观察研究中,基于FFR的冠状动脉病变延迟治疗策略是一种可靠且安全的工具,与良好的结果相关。
    NCT03079739。
    UNASSIGNED: Recently, questions around the efficacy and effectiveness of Fractional Flow Reserve (FFR) have arisen in various clinical settings.
    UNASSIGNED: The Clinical Outcome of FFR-guided Revascularization Strategy of Coronary Lesions (HALE-BOPP) study is an investigator-initiated, multicentre, international prospective study enrolling patients who underwent FFR measurement on at least one vessel. In accordance with the decision-making workflow and treatment, the vessels were classified in three subgroups: (i) angio-revascularized, (ii) FFR-revascularized, (iii) FFR-deferred. The primary endpoint was the occurrence of target vessel failure (TVF, cardiac death, target vessel myocardial infarction and ischemia-driven target vessel revascularization). The analysis was carried out at vessel- and patient-level.
    UNASSIGNED: 1305 patients with 2422 diseased vessels fulfilled the criteria for the present analysis. Wire-related pitfalls and transient adenosine-related side effects occurred in 0.8% (95% CI: 0.4%-1.4%) and 3.3% (95% CI: 2.5%-4.3%) of cases, respectively. In FFR-deferred vessels, the overall incidence rate of TVF was 0.024 (95% CI: 0.019-0.031) lesion/year. After a median follow-up of 3.6 years, the occurrence of TVF was 6%, 7% and 11.7% in FFR-deferred, FFR-revascularized and angio-revascularized vessels, respectively. Compared to angio-revascularized vessels, FFR-guided vessels (both FFR-revascularized and FFR-deferred vessels) showed a lower TVF incidence rate lesion/year (0.029, 95% CI: 0.024-0.034 vs. 0.049, 95% CI: 0.040-0.061 respectively, p = 0.0001). The result was consistent after correction for confounding factors and across subgroups of clinical interest. The patient-level analysis confirmed the lower occurrence of TVF in negative-FFR vs. positive-FFR subgroups.
    UNASSIGNED: In a large prospective observational study, an FFR-based strategy for the deferral of coronary lesions is a reliable and safe tool, associated with good outcomes.
    UNASSIGNED: NCT03079739.
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  • 文章类型: Journal Article
    冠状动脉疾病(CAD)通常在下肢动脉疾病(LEAD)患者中出现。然而,CAD对LEAD患者的影响尚未明确研究.在这项研究中,研究CAD对无慢性威胁肢体缺血(CLTI)的LEAD患者的影响,我们比较了有和无CAD患者的5年临床结局.在2014年至2017年期间,246例无CLTI的症状性LEAD患者接受了血管内治疗。有CAD血运重建或CAD研究定义的CAD病史的患者被分为CAD组。其他人是非CAD组。排除不合格患者后,倾向匹配产生了每组40名患者,并比较两组间的临床结局.使用CAD和非CAD组之间的五年Kaplan-Meier分析,生存率无显著差异(90.0%vs92.5%,p=0.693),无心血管事件(42.5%vs57.5%,p=0.110),无LEAD血运重建(67.5%vs67.5%,p=0.940),和不受CLTI的影响(100%vs.95.0%,p=0.148)。然而,在无CAD血运重建方面观察到显著差异(67.5%vs97.5%,p<0.001)和无症状性CAD(85.0%vs97.5%,p=0.048)。我们的结果表明,在没有CLTI的LEAD患者中,CAD导致CAD血运重建和症状性CAD增加。然而,CAD没有影响生存,心血管事件,导致血运重建,或CLTI在这样的患者。当在没有CLTI的LEAD患者中观察到CAD时,更频繁的CAD随访可能改善此类患者的长期临床结局.
    Coronary artery disease (CAD) is often noted in patients with lower-extremity artery disease (LEAD). However, the effects of CAD on patients with LEAD have not been clearly investigated. In this study, to investigate the effect of CAD on patients with LEAD without chronic limb-threatening ischemia (CLTI), we compared the five-year clinical outcomes of patients with and without CAD. Between 2014 and 2017, 246 patients with symptomatic LEAD without CLTI underwent endovascular treatment. Patients with a history of CAD revascularization or CAD defined by CAD studies were divided into CAD groups, and others were non-CAD groups. After excluding ineligible patients, propensity matching produced 40 patients in each group, and clinical outcomes were compared between the groups. Using five years of Kaplan-Meier analysis between the CAD and non-CAD groups, no significant differences were observed in survival (90.0% vs 92.5%, p=0.693), freedom from cardiovascular events (42.5% vs 57.5%, p=0.110), freedom from LEAD revascularization (67.5% vs 67.5%, p=0.940), and freedom from CLTI (100% vs. 95.0%, p=0.148). However, significant differences were observed in freedom from CAD revascularization (67.5% vs 97.5%, p<0.001) and freedom from symptomatic CAD (85.0% vs 97.5%, p=0.048). Our results suggest that in patients with LEAD without CLTI, CAD caused increased CAD revascularization and symptomatic CAD. However, CAD did not affect survival, cardiovascular events, LEAD revascularization, or CLTI in such patients. When CAD was observed in patients with LEAD without CLTI, more frequent follow-up of CAD may improve the long-term clinical outcomes of such patients.
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  • 文章类型: Journal Article
    背景:晚期慢性肾脏病(ACKD)在经皮冠状动脉介入治疗(PCI)的患者中很常见。PCI术后出血已被证明会增加死亡率,并且在这些患者中仍然是一个重要的挑战。先前的研究表明CKD患者PCI后出血增加,但通常ACKD患者被排除在这些试验之外。这项研究的目的是评估接受PCI治疗的晚期肾病患者是否有更高的出血并发症。
    方法:我们分析了国家住院患者样本(NIS)数据库,以比较2006年至2011年间接受PCI的ACKD(CKD3期及以上)与未接受ACKD的患者的PCI后出血率。使用特定的ICD-9CM代码来识别这些患者。
    结果:在研究期间,共有49,192例患者出现PCI术后出血,其中3,675例(7.5%)出现ACKD。ACKD患者年龄较大(68.7±11.7岁)。在学习期间,ACKD组和对照组的PCI术后出血率都有所下降.ACKD患者PCI术后出血率明显高于对照组。例如,2006年,ACKD患者中有133.9例出血与没有ACKD的患者为104.4/100,000(P<0.05)。在对巴斯线合并症进行多变量调整后,ACKD与PCI术后出血风险独立相关(OR:1.07,CI:1.03-1.11,P<0.001)。
    结论:尽管PCI术后出血总体下降,但ACKD仍与术后出血独立相关。
    BACKGROUND: Advanced chronic kidney disease (ACKD) is common in patients undergoing percutaneous coronary intervention (PCI). Post-PCI bleeding has been shown to increase mortality and remains an important challenge in these patients. Previous studies have shown increased post-PCI bleeding in CKD patients but often ACKD patients are excluded from these trials. The goal of this study was to evaluate if patients undergoing PCI with advanced renal disease have higher bleeding complications.
    METHODS: We analyzed the National Inpatient Sample (NIS) database to compare the post-PCI bleeding rates for ACKD (CKD stage 3 and above) undergoing PCI between 2006 and 2011 to those without ACKD in patients over the age of 40. Specific ICD-9 CM codes were used to identify these patients.
    RESULTS: A total of 49,192 patients had post-PCI bleeding during the study period of which 3,675 (7.5%) had ACKD. Patients with ACKD were older (68.7±11.7 years). During the study period, there was a decline in post-PCI bleeding rates in both ACKD and control groups. Patients with ACKD have significantly higher post-PCI bleeding rates compared to the control group. For example, in 2006, 133.9 in patients with ACKD had bleeding vs. 104.4 per 100,000 in patients without ACKD (P<0.05). After multivariate adjustment for bassline comorbidities, ACKD remained independently associated with post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001).
    CONCLUSIONS: Despite the overall decline in post-PCI bleeding in patients undergoing PCI, ACKD remains independently associated with post-procedural bleeding.
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  • 文章类型: Journal Article
    背景:完全冠状动脉血运重建相对于非侵入性检测方法的预后影响尚不清楚。
    目的:评估由CTA衍生的血流储备分数(FFRCT)定义的血运重建的完整性与稳定型心绞痛患者心血管结局之间的关系。
    方法:通过CTA对新发作的稳定型心绞痛和≥30%狭窄的患者进行多中心3年随访研究。在所有狭窄的血管中记录了病变特异性FFRCT值(狭窄远端2cm),当≤0.80时被认为是异常的。FFRCT≤0.80的患者分为:完全血运重建(CR-FFRCT),所有FFRCT≤0.80血管重建;未完全血管重建(IR-FFRCT),FFRCT≤0.80的≥1条血管未血管重建。早期血运重建(CTA指数<90天)将血管分类为血运重建。主要终点包括心血管死亡和非致死性心肌梗死;次要终点血管特异性晚期血运重建和非致死性心肌梗死。
    结果:在900名患者和1759条血管中,377例(42%)患者的FFRCT≤0.80,536(30%)血管;244(27%)患者进行了血运重建,340(19%)船。与CR-FFRCT(4/167[2.4%])相比,IR-FFRCT(15/210[7.1%])的主要终点风险更高,RR:2.98;95%CI:1.01-8.8,p=0.036,达到正常FFRCT(3/523[0.6%]),RR:12.45;95%CI:3.6-42.6,p<0.001。与FFRCT≤0.80(29/250[12%])的非血运重建血管相比,FFRCT≤0.80(5/286[1.7%])的次要终点发生率更高,p​=0.001,对于FFRCT>0.80(10/1223[0.8%])的血管,p<0.001。
    结论:与完全血运重建或FFRCT>0.80相比,病变特异性FFRCT≤0.80的患者不完全血运重建与不良心血管结局相关。
    BACKGROUND: The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.
    OBJECTIVE: To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFRCT) and cardiovascular outcomes in patients with stable angina.
    METHODS: Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFRCT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFRCT ≤ 0.80 were categorized as: Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤ 0.80 revascularized; incompletely revascularized (IR-FFRCT), ≥ 1 vessels with FFRCT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
    RESULTS: Amongst 900 patients and 1759 vessels, FFRCT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFRCT (15/210 [7.1%]) compared to CR-FFRCT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p ​= ​0.036, and to normal FFRCT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p ​< ​0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFRCT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFRCT ≤ 0.80 (5/286 [1.7%]), p ​= ​0.001, and to vessels with FFRCT > 0.80 (10/1223 [0.8%]), p ​< ​0.001.
    CONCLUSIONS: Incomplete revascularization of patients with lesion-specific FFRCT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFRCT > 0.80.
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  • 文章类型: Journal Article
    背景:冠状动脉疾病是全球死亡的主要原因。微创直接冠状动脉搭桥术(MIDCAB),用左前胸小切开术,旨在为传统手术提供一种侵入性较小的替代方案,可能改善患者预后,减少恢复时间。方法:回顾性分析,非随机研究分析了在1999年7月至2022年4月期间接受MIDCAB的310例患者.收集了人口统计数据,临床特征,手术和术后结果,以及随访死亡率和发病率。使用IBMSPSS进行统计分析,通过Kaplan-Meier方法生成的存活曲线。结果:该队列的平均年龄为63.3±10.9岁,女性占30.6%。大多数手术是选择性的(76.1%),平均运行时间为129.7±35.3min。术中输血的中位数为0.0(CI0.0-2.0)单位。平均住院时间为8.7±5.5天,ICU住院的中位数只有一天。术后早期并发症很少,住院死亡率为0.64%。6个月和1年死亡率为0.97%,10年生存率为94.3%。有2例围手术期心肌梗死,没有中风或新发作的透析病例。结论:MIDCAB方法在患者康复和长期预后方面显示出显著的益处。为患者提供了一个可行和有效的替代方案,适用于侵入性较小的程序。我们的结果表明,MIDCAB是一个安全的选择,具有良好的生存率,在专注于微创技术的高容量中心证明其考虑是合理的。
    Background: Coronary artery disease is a major cause of death globally. Minimally invasive direct coronary artery bypass (MIDCAB), using a small left anterior thoracotomy, aims to provide a less invasive alternative to traditional procedures, potentially improving patient outcomes with reduced recovery times. Methods: This retrospective, non-randomized study analyzed 310 patients who underwent MIDCAB between July 1999 and April 2022. Data were collected on demographics, clinical characteristics, operative and postoperative outcomes, and follow-up mortality and morbidity. Statistical analysis was conducted using IBM SPSS, with survival curves generated via the Kaplan-Meier method. Results: The cohort had a mean age of 63.3 ± 10.9 years, with 30.6% females. The majority of surgeries were elective (76.1%), with an average operating time of 129.7 ± 35.3 min. The median rate of intraoperative blood transfusions was 0.0 (CI 0.0-2.0) Units. The mean in-hospital stay was 8.7 ± 5.5 days, and the median ICU stay was just one day. Early postoperative complications were minimal, with a 0.64% in-hospital mortality rate. The 6-month and 1-year mortalities were 0.97%, with a 10-year survival rate of 94.3%. There were two cases of perioperative myocardial infarction and no instances of stroke or new onset dialysis. Conclusions: The MIDCAB approach demonstrates significant benefits in terms of patient recovery and long-term outcomes, offering a viable and effective alternative for patients suitable for less invasive procedures. Our results suggest that MIDCAB is a safe option with favorable survival rates, justifying its consideration in high-volume centers focused on minimally invasive techniques.
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  • 文章类型: Journal Article
    目的:在心血管疾病预防中使用ω-3脂肪酸的益处存在争议。特别是,对冠状动脉血运重建的影响尚不清楚;还有争议的是二十碳五烯酸(EPA)的具体益处.我们调查了偶然的冠状动脉血运重建,心肌梗死(MI),中风,心力衰竭(HF),不稳定型心绞痛,和心血管死亡,在随机接受EPA或EPA+二十二碳六烯酸(EPA+DHA)的受试者中,控制。
    结果:在MEDLINE,Embase,Scopus,WebofScience,和科克伦图书馆搜索。遵循系统审查和荟萃分析指南的首选报告项目,以提取数据并评估数据质量和有效性。使用随机效应模型汇集数据。18项RCT,134144名参与者(初级和二级心血管预防)接受DHA+EPA(n=52498),仅EPA(n=14640),或对照/安慰剂(n=67006)包括在内。随访时间为4.5个月至7.4年。总的来说,与对照组相比,补充omega-3可降低血运重建的风险[0.90,95%置信区间(CI)0.84-0.98;P=0.001;P-异质性=0.0002;I2=68%],MI(0.89,95%CI0.81-0.98;P=0.02;P异质性=0.06;I2=41%),和心血管死亡(0.92,95%CI0.85-0.99;P=0.02;P异质性=0.13;I2=33%)。在大多数参与者(≥60%)接受他汀类药物治疗的试验中,仍观察到较低的风险。与DHA+EPA相比,仅EPA显示血运重建的风险进一步显着降低(0.76,95%CI0.65-0.88;P=0.0002;P-交互作用=0.005)和除HF以外的所有结果。
    结论:补充Omega-3脂肪酸可降低心血管事件和冠状动脉血运重建的风险,无论使用他汀类药物的背景如何。单独的二十碳五烯酸产生更大的益处。特定omega-3分子在原发性与原发性中的作用二级预防以及减少血运重建对总体健康状况和成本节约的潜在益处值得进一步研究.
    药物施用ω-3脂肪酸是否减少心脏事件存在争议。特别是,目前尚不清楚是否实际上仅限于使用二十碳五烯酸(EPA),或是否需要EPA+二十二碳六烯酸(DHA)的联合给药;此外,关于omega-3脂肪酸在降低冠状动脉血运重建手术发生率方面的可能益处知之甚少.在这项对所有已发表的临床试验证据的荟萃分析中,将EPA单独或EPADHA与控制(134144参与者),我们证明了以下几点:在所有试验的总体分析中,补充omega-3可降低心肌梗死和心血管死亡的风险,在适度的程度上。然而,当单独使用EPA的试验进行单独分析时,研究表明,心血管结局的风险进一步显著降低.重要的是,在已经将他汀类药物作为慢性治疗的一部分的受试者中也观察到了这些益处.服用omega-3脂肪酸,特别是EPA单独,还与随后的冠状动脉血运重建的风险大幅降低相关。减少血运重建程序可能会对总体健康状况和相关成本节省产生额外的益处。
    OBJECTIVE: Benefits of pharmacologic omega-3 fatty acid administration in cardiovascular prevention are controversial. Particularly, effects on coronary revascularization are unclear; also debated are specific benefits of eicosapentaenoic acid (EPA). We investigated incident coronary revascularizations, myocardial infarction (MI), stroke, heart failure (HF), unstable angina, and cardiovascular death, in subjects randomized to receive EPA or EPA + docosahexaenoic acid (EPA + DHA) vs. control.
    RESULTS: Meta-analysis of randomized controlled trials (RCTs) was conducted after MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library search. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed for abstracting data and assessing data quality and validity. Data were pooled using a random effects model. Eighteen RCTs with 134 144 participants (primary and secondary cardiovascular prevention) receiving DHA + EPA (n = 52 498), EPA alone (n = 14 640), or control/placebo (n = 67 006) were included. Follow-up ranged from 4.5 months to 7.4 years. Overall, compared with controls, omega-3 supplementation reduced the risk of revascularization [0.90, 95% confidence interval (CI) 0.84-0.98; P = 0.001; P-heterogeneity = 0.0002; I2 = 68%], MI (0.89, 95% CI 0.81-0.98; P = 0.02; P-heterogeneity = 0.06; I2 = 41%), and cardiovascular death (0.92, 95% CI 0.85-0.99; P = 0.02; P-heterogeneity = 0.13; I2 = 33%). Lower risk was still observed in trials where most participants (≥60%) were on statin therapy. Compared with DHA + EPA, EPA alone showed a further significant risk reduction of revascularizations (0.76, 95% CI 0.65-0.88; P = 0.0002; P-interaction = 0.005) and all outcomes except HF.
    CONCLUSIONS: Omega-3 fatty acid supplementation reduced the risk of cardiovascular events and coronary revascularization, regardless of background statin use. Eicosapentaenoic acid alone produced greater benefits. The role of specific omega-3 molecules in primary vs. secondary prevention and the potential benefits of reduced revascularizations on overall health status and cost savings warrant further research.
    It is debated whether pharmacologic administration of omega-3 fatty acids reduces cardiac events. In particular, it is unclear whether benefits are actually restricted to the use of eicosapentaenoic acid (EPA), or whether combined administration of EPA + docosahexaenoic acid (DHA) is needed; furthermore, little is known about possible benefits of omega-3 fatty acids in reducing incidence of coronary revascularization procedures. In this meta-analysis of all published evidence of clinical trials comparing EPA alone or EPA + DHA vs. control (134 144 participants), we demonstrate the following: In the overall analysis of all trials, omega-3 supplementation reduced the risk of myocardial infarction and cardiovascular death, to a modest extent. However, when trials administering EPA alone were separately analysed, a further significant risk reduction for cardiovascular outcomes was demonstrated. Importantly, these benefits were also observed in subjects who were already taking statins as part of their chronic therapy.Administration of omega-3 fatty acids, particularly EPA alone, was also associated with a substantial decrease in the risk for subsequent coronary revascularizations. Reduction of revascularization procedures may induce additional benefits on overall health status and associated cost savings.
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