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近年公布的几项临床研究结果对冠状动脉粥样硬化性心脏病(冠心病)介入治疗提出了质疑和挑战。COURAGE研究结果表明,对稳定型冠心病患者的强化药物治疗效果并不比经皮冠状动脉介入治疗(PCI)差。多项研究结果提示,药物洗脱支架(DES)迟发性血栓风险增高是客观存在的,适当延长术后两联抗血小板治疗时间,用新型的DES取代现有的DES可进一步减少迟发性血栓的风险。CA-DILL和ICTUS研究结果分别证实了接受PCI的非ST段抬高心肌梗死(NSTEMI)患者晚期效果不如ST段抬高心肌梗死(STEMI)患者,早期积极PCI治疗NSTEMI无额外益处。新临床证据否定了急性心肌梗死患者的易化PCI和延期PCI。
Several clinical studies published in recent years have challenged the interventional treatment of coronary atherosclerotic heart disease (CHD). COURAGE results show that patients with stable coronary heart disease with enhanced drug treatment than percutaneous coronary intervention (PCI) is poor. A number of studies suggest that the increased risk of delayed thrombosis in DES is objective and appropriate to prolong postoperative dual antiplatelet therapy. The replacement of existing DES with newer DES may further reduce the delayed Thrombosis risk. The results of CA-DILL and ICTUS confirmed that patients with non-ST-segment elevation myocardial infarction (NSTEMI) receiving PCI had less advanced effects than those with ST-elevation myocardial infarction (STEMI), respectively. There was no additional benefit of early active PCI for NSTEMI. New clinical evidence denied the facilitation of PCI and delayed PCI in patients with acute myocardial infarction.