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[大学生论坛]:冠状动脉CT血管造影和5年心肌梗死风险

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Vaness-A 发表于 2019-1-4 10:17:41 | 显示全部楼层 |阅读模式
Coronary CT Angiography and 5-Year Risk of Myocardial Infarction
冠状动脉CT血管造影和5心肌梗死风险

Abstract
摘要

BACKGROUND
背景

Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.
虽然冠状动脉计算机断层扫描血管造影(CTA)提高了对稳定性胸痛患者评估的诊断确定性,但其对5年临床结果的影响尚不清楚。


METHODS
方法

In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years.
在一项开放标签多中心平行组试验中,我们随机分配了4146被转诊至心脏病诊所患有稳定性胸痛的患者,分别给予标准治疗+CTA2073名患者)或单独标准治疗(2073名患者)。在37年的随访中评估调查治疗和临床结果。主要终点是5年时冠心病所致死亡或非致死性心肌梗死。


RESULTS
结果

The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause.
中位随访时间为4.8年,随访时间为20,254患者年。CTA组的主要终点5年率低于标准治疗组(2.3[483.9[81];风险比0.59; 95%置信区间[CI ]0.410.84; P = 0.004)。尽管CTA组的侵袭性冠状动脉造影和冠状动脉血运重建率在随访的前几个月比标准治疗组高,但总体发生率在5年时相似:CTA491名患者和标准治疗组的502名患者接受了侵入性冠状动脉造影。(风险比,1.00; 95CI0.881.13CTA组的279名患者和标准治疗组的267名患者接受了冠状动脉血运重建(风险比,1.07; 95CI0.911.27)。然而,CTA组患者接受更多的预防性治疗(比值比,1.40; 95CI1.19-1.65),抗心绞痛治疗(比值比,1.27; 95CI1.05-1.54)。任何原因导致的心血管或非心血管死亡率或死亡率之间没有显着的组间差异。


CONCLUSIONS
结论

In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590.)
在这项试验稳定性胸痛患者中,与单独标准治疗相比标准治疗加CTA的使用5年内冠心病或非致死性心肌梗死的死亡率明显降低,但没有显着提高冠状动脉造影或冠状动脉血运重建术的发生率 (由苏格兰政府首席科学家办公室资助; SCOT-HEART ClinicalTrials.gov注册号为NCT01149590。)

[size=18.6667px]作者:The SCOT-HEART Investigators*
[size=18.6667px]
发表时间:September 6, 2018
N Engl J Med 2018; 379:924-933
DOI: 10.1056/NEJMoa1805971
https://www.nejm.org/doi/full/10.1056/NEJMoa1805971
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