冠脈疾病侵入性治療的心絞痛相關健康狀況優於保守方案
作者：
小柯機器人發布時間：2020/4/2 16:00:31
美國密蘇裡大學堪薩斯城分校John A. Spertus課題組比較了冠狀動脈疾病侵入或保守治療的健康狀況結果。這一研究成果於2020年3月30日發表在《新英格蘭醫學雜誌》上。
在ISCHEMIA試驗中，採用血管造影評估和血運重建的侵入性方案並未減少穩定型缺血性心臟病、中度或重度缺血患者的臨床事件。該試驗的次要目標是評估這些患者與心絞痛有關的健康狀況。
研究組對此前2295名接受侵入性治療的患者，以及2322名接受保守方案的患者進行了西雅圖心絞痛問卷（SAQ）調查，分別於1.5、3和6個月進行，之後每6個月一次，對心絞痛相關症狀、功能和生活質量進行評估。此健康分析的主要結果是SAQ得分，0-100，分數越高越健康。
基線時，有35%的患者報告前一個月沒有心絞痛。兩個治療組的SAQ總分均增加，侵入性治療組在3、12和36個月的得分分別比保守方案組高4.1分、4.2分和2.9分。基線時心絞痛發作頻率更高的參與者之間差異更大。
總之，對於總體中度或重度缺血人群，接受侵入性治療與保守方案相比，與心絞痛相關的健康狀況有較大改善。無症狀患者之間差異最小，基線時有心絞痛的患者之間差異較大。
附：英文原文
Title: Health-Status Outcomes with Invasive or Conservative Care in Coronary Disease | NEJM
Author: John A. Spertus, M.D., M.P.H.,, Philip G. Jones, M.S.,, David J. Maron, M.D.,, Sean M. O』Brien, Ph.D.,, Harmony R. Reynolds, M.D.,, Yves Rosenberg, M.D., M.P.H.,, Gregg W. Stone, M.D.,, Frank E. Harrell, Jr., Ph.D.,, William E. Boden, M.D.,, William S. Weintraub, M.D.,, Khaula Baloch, M.P.H.,, Kreton Mavromatis, M.D.,, Ariel Diaz, M.D.,, Gilbert Gosselin, M.D.,, Jonathan D. Newman, M.D., M.P.H.,, Stavroula Mavromichalis, M.S.,, Karen P. Alexander, M.D.,, David J. Cohen, M.D.,, Sripal Bangalore, M.D., M.H.A.,, Judith S. Hochman, M.D.,, and Daniel B. Mark, M.D., M.P.H.
Issue&Volume: 2020-03-30
Abstract: Abstract
Background
In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.
Methods
We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency.
Results
At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina).
Conclusions
In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline.
DOI: 10.1056/NEJMoa1916370
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1916370