Coronary revascularisation in stable patients after an acute coronary syndrome: a propensity analysis of early invasive versus conservative management in a register-based cohort study
Coronary revascularisation in stable patients after an acute coronary syndrome: a propensity analysis of early invasive versus conservative management in a register-based cohort study
复制标题
DOI：
10.1136/bmjopen-2013-002559
复制
发表时间：
2013-01-01
期刊：
影响因子：
2.9
通讯作者：
Nikus, Kjell
中科院分区：
文献类型：
--
作者：
Bugiardini, Raffaele;Eskola, Markku;Nikus, Kjell
目的 比较住院药物治疗与冠状动脉血运重建加药物治疗对急性冠脉综合征 (ACS) 后病情稳定的患者的有效性。设计来自坦佩雷 ACS 登记数据库的倾向评分匹配队列研究。设置在芬兰的一家学术医院。参与者 1149 名近期患有 ACS 的患者，但没有严重的共存疾病：复发 尽管进行了充分的药物治疗，但仍出现缺血性发作、血流动力学不稳定、明显的充血性心力衰竭和严重的室性心律失常。主要和次要结局指标主要急性心血管事件（MACE）的复合终点：6个月随访时需要再住院的不稳定型心绞痛、中风、心肌梗死和全因死亡率。结果与标准药物治疗相比， 对于第一个五分位数的患者，血运重建与 6 个月时较低的 MACE 发生率相关（HR 0.81；95% CI 0.66 - 0.99），但第五个五分位数的患者 MACE 发生率较高（HR 4.74，CI 1.36 - 16.49；p=0.014）。其余三个五分位数的 MACE 发生率没有显着差异。第一个五分位数的患者年龄最大 (79.78.3 岁)，并且具有更显着的 (p
Objectives To compare the effectiveness of in-hospital medical therapy versus coronary revascularisation added to medical therapy in patients who stabilised after an acute coronary syndrome (ACS).Design Propensity score-matched cohort study from the database of the Tampere ACS registry.Setting A single academic hospital in Finland.Participants 1149 patients with a recent ACS, but no serious coexisting conditions: recurrent ischaemic episodes despite adequate medical therapy, haemodynamic instability, overt congestive heart failure and serious ventricular arrhythmias.Primary and secondary outcome measures The composite endpoint of major acute cardiovascular events (MACEs): unstable angina requiring rehospitalisation, stroke, myocardial infarction and all-cause mortality, at 6-month follow-up.Results Compared with standard medical treatment, revascularisation was associated with a lower rate of MACEs at 6months in patients of the first quintile (HR 0.81; 95% CI 0.66 to 0.99), but a higher rate of MACEs in the fifth quintile (HR 4.74, CI 1.36 to 16.49; p=0.014). There were no significant differences in the rates of MACEs in the remaining three quintiles. Patients of the first quintile were the oldest (79.78.3years) and had a more significant (p