Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA.
Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA.
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DOI：
10.1007/s12350-013-9773-4
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发表时间：
2013-12
影响因子：
2.4
通讯作者：
Shaw, Leslee J.
中科院分区：
文献类型：
--
作者：
Phillips, Lawrence M.;Hachamovitch, Rory;Berman, Daniel S.;Iskandrian, Ami E.;Min, James K.;Picard, Michael H.;Kwong, Raymond Y.;Friedrich, Matthias G.;Scherrer-Crosbie, Marielle;Hayes, Sean W.;Sharir, Tali;Gosselin, Gilbert;Mazzanti, Marco;Senior, Roxy;Beanlands, Rob;Smanio, Paola;Goyal, Abhi;Al-Mallah, Mouaz;Reynolds, Harmony;Stone, Gregg W.;Maron, David J.;Shaw, Leslee J.
有大量证据表明，在急性冠状动脉综合征的情况下，采用冠状动脉血运重建术的侵入性入路具有发病率和死亡率的优势。然而，最近的稳定性缺血性心脏病（SIHD）随机临床试验测试了在指南导向的药物治疗（GDMT）中加入冠状动脉血运重建术是否会减少死亡或主要心血管事件，结果是阴性的。根据这些试验的证据，GDMT作为一线医疗管理方法的主要作用已在最近的SIHD临床实践指南中明确定义；迅速血运重建的作用还不太明确。根据观察性研究的数据，假设存在一定程度的缺血，超过该程度，血运重建策略可能对心血管事件有益。然而，最近的SIHD阴性试验的资格要求缺血的最低标准。一项正在进行的随机试验将正式验证这一假设，该试验将评估随机化患者进行冠状动脉造影和血运重建术与不进行冠状动脉造影和GDMT相比的有效性。目前的审查将强调现有证据，包括对已发表和正在进行的SIHD试验的审查。
There is a preponderance of evidence that, in the setting of an acute coronary syndrome, an invasive approach using coronary revascularization has a morbidity and mortality benefit. However, recent stable ischemic heart disease (SIHD) randomized clinical trials testing whether the addition of coronary revascularization to guideline-directed medical therapy (GDMT) reduces death or major cardiovascular events have been negative. Based on the evidence from these trials, the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline; the role of prompt revascularization is less precisely defined. Based on data from observational studies, it has been hypothesized that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events. However, eligibility for recent negative trials in SIHD has mandated at most minimal standards for ischemia. An ongoing randomized trial evaluating the effectiveness of randomization of patients to coronary angiography and revascularization as compared to no coronary angiography and GDMT in patients with moderate-severe ischemia will formally test this hypothesis. The current review will highlight the available evidence including a review of the published and ongoing SIHD trials.
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影响因子：
24
作者：
Fihn, Stephan D.;Gardin, Julius M.;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.
影响因子：
2.4
作者：
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Iskandrian, Ami E.
影响因子：
2.4
作者：
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影响因子：
24
作者：
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通讯作者：
De Bruyne, Bernard
影响因子：
2.8
作者：
Christou, Maria A. C.;Siontis, George C. M.;Ioannidis, John P. A.
通讯作者：
Ioannidis, John P. A.