冠心病介入诊疗管理信息网_冠脉钙化可以恢复吗

编程小6 (2) 2024-08-29 13:23

Hi，大家好，我是编程小6，很荣幸遇见你，我把这些年在开发过程中遇到的问题或想法写出来，今天说一说
冠心病介入诊疗管理信息网_冠脉钙化可以恢复吗,希望能够帮助你!!!。

《新英格兰医学杂志》2017年12月21日377:2419-2432

心源性休克的急性心肌梗塞患者经皮冠状动脉介入治疗策略

Holger Thiele, M.D., Ibrahim Akin, M.D., Marcus Sandri, M.D., Georg Fuernau, M.D., Suzanne de Waha, M.D., Roza Meyer-Saraei, Ph.D., Peter Nordbeck, M.D., Tobias Geisler, M.D., Ulf Landmesser, M.D., Carsten Skurk, M.D., Andreas Fach, M.D., Harald Lapp, M.D., Jan J. Piek, M.D., Ph.D., Marko Noc, M.D., Tomaž Goslar, M.D., Stephan B. Felix, M.D., Lars S. Maier, M.D., Janina Stepinska, M.D., Keith Oldroyd, M.D., Pranas Serpytis, M.D., Gilles Montalescot, M.D., Olivier Barthelemy, M.D., Kurt Huber, M.D., Stephan Windecker, M.D., Stefano Savonitto, M.D., Patrizia Torremante, B.Sc., Christiaan Vrints, M.D., Steffen Schneider, Ph.D., Steffen Desch, M.D., and Uwe Zeymer, M.D., for the CULPRIT-SHOCK Investigators*

N Engl J Med 2017; 377:2419-2432December 21, 2017DOI: 10.1056/NEJMoa

背景

在急性心肌梗塞伴心源性休克患者中，通过经皮冠状动脉介入治疗（PCI）对罪犯血管进行早期血管重建可以改善预后，但心源性休克患者绝大多数有多支血管病变，对非罪犯血管的狭窄是否应当立即进行PCI尚存争议。

方法

在这项多中心临床试验中，我们随机将706名有多支病变的心源性休克的急性心肌梗塞患者分组，一组仅对罪犯病变部位进行PCI，然后选择分期对非罪犯病变进行血管重建，一组即刻进行多支血管的PCI。主要终点为复合终点，即随机化后30天内死亡或需要肾脏替代治疗的严重肾衰，安全性终点包括出血和脑卒中。

结果

30天时，仅罪犯血管病变进行PCI组344名患者中有158名（45.9%）出现死亡或肾脏替代治疗的复合终点事件，多支血管PCI组341名患者中有189名（55.4%）出现死亡或肾脏替代治疗的复合终点事件（相对风险，0.83；95%置信区间[CI]，0.71-0.96；P=0.01）。仅罪犯病变进行PCI组与多支血管PCI组相比较，死亡的相对风险为0.84（95%CI，0.72-0.98；P=0.03）、肾脏替代治疗的相对风险为0.71（95%CI，0.49-1.03；P=0.07）。血流动力学稳定的时间、儿茶酚胺治疗的风险及儿茶酚胺治疗的持续时间、肌钙蛋白T和肌酸激酶水平、出血和脑卒中发生率，两组间没有明显差异。

结论

在冠状动脉多支病变的伴有心源性休克的急性心肌梗塞患者中，对于死亡或需要肾脏替代治疗的严重肾衰的复合终点事件，初期仅进行罪犯病变血管PCI患者30天出现复合终点的风险低于即刻进行多支血管PCI患者。（Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT0）

《壹篇》南南和北北

PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

N Engl J Med 2017; 377:2419-2432December 21, 2017DOI: 10.1056/NEJMoa

Background

In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial.

Methods

In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke.

Results

At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups.

Conclusions

Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI. (Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT0.)