Randomized Trial of Preventive Angioplasty in Myocardial Infarction
Randomized Trial of Preventive Angioplasty in Myocardial Infarction
复制标题
DOI：
10.1056/nejmoa1305520
复制
发表时间：
2013-09-19
影响因子：
158.5
通讯作者：
Oldroyd, Keith G.
中科院分区：
文献类型：
--
作者：
Wald, David S.;Morris, Joan K.;Oldroyd, Keith G.
背景在急性ST段抬高型心肌梗死（STEMI）中，使用经皮冠状动脉介入治疗（PCI）治疗导致梗死的动脉（梗死或罪犯动脉）可改善预后。经皮冠状动脉介入治疗在非梗死冠状动脉严重狭窄中的价值方法从2008年到2013年，在英国的五个中心，我们招募了465名急性STEMI患者，（包括3例左冠状动脉传导阻滞患者）接受梗死动脉PCI，并将其随机分配至预防性PCI组和对照组。（234例患者）或无预防性PCI（231例患者）。仅推荐对有缺血客观证据的难治性心绞痛进行后续PCI治疗。主要结局是心脏原因死亡、非致死性心肌梗死或难治性心绞痛的复合终点。意向治疗分析used.ResultsBy 2013年1月，结果被认为是结论性的数据和安全监测委员会，建议该试验提前停止。在平均23个月的随访中，21例接受预防性PCI的患者和53例未接受预防性PCI的患者发生了主要结局（仅梗死动脉PCI），分别转化为每100例患者9例事件和每100例患者23例事件的发生率（预防性PCI组的风险比为0.35; 95%置信区间[CI]，0.21至0.58; P
BackgroundIn acute ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to treat the artery responsible for the infarct (infarct, or culprit, artery) improves prognosis. The value of PCI in noninfarct coronary arteries with major stenoses (preventive PCI) is unknown.MethodsFrom 2008 through 2013, at five centers in the United Kingdom, we enrolled 465 patients with acute STEMI (including 3 patients with left bundle-branch block) who were undergoing infarct-artery PCI and randomly assigned them to either preventive PCI (234 patients) or no preventive PCI (231 patients). Subsequent PCI for angina was recommended only for refractory angina with objective evidence of ischemia. The primary outcome was a composite of death from cardiac causes, nonfatal myocardial infarction, or refractory angina. An intention-to-treat analysis was used.ResultsBy January 2013, the results were considered conclusive by the data and safety monitoring committee, which recommended that the trial be stopped early. During a mean follow-up of 23 months, the primary outcome occurred in 21 patients assigned to preventive PCI and in 53 patients assigned to no preventive PCI (infarct-artery-only PCI), which translated into rates of 9 events per 100 patients and 23 per 100, respectively (hazard ratio in the preventive-PCI group, 0.35; 95% confidence interval [CI], 0.21 to 0.58; P