美国密苏里大学堪萨斯城分校John A. Spertus课题组比较了冠状动脉疾病侵入或保守治疗的健康状况结果。这一研究成果于2020年3月30日发表在《新英格兰医学杂志》上。
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.
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.
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.
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).
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.
The New England Journal of Medicine：《新英格兰医学杂志》，创刊于1812年。隶属于美国麻省医学协会，最新IF：70.67