關(guān)注心血管病殘余風(fēng)險(xiǎn)-閱讀頁(yè)
2024-10-19 13:44本頁(yè)面
【正文】 patients, of whom 2,692 (79% male, mean age 57 11 years) discontinued OAT 3 to 6 ? months after ablation (OffOAT group) and 663 (70% male, mean age 59 11 years) remained on OAT after ? this period (OnOAT group). CHADS2 (congestive heart failure, hypertension, age [75 years and older], diabetes mellitus, ? and a history of stroke or transient ischemic attack) risk scores of 1 and 2 were recorded in 723 (27%) and ? 347 (13%) OffOAT group patients and in 261 (39%) and 247 (37%) OnOAT group patients, respectively. ? Results During followup (mean 28 13 months vs. 24 15 months), 2 (%) OffOAT group patients and 3 (%) ? OnOAT group patients had an ischemic stroke (p ). No other thromboembolic events occurred. No Off ? OAT group patient with a CHADS2 risk score of 2 had an ischemic stroke. A major hemorrhage was observed ? in 1 (%) OffOAT group patient and 13 (2%) OnOAT group patients (p ). ? Conclusions In this nonrandomized study, the risk–benefit ratio favored the suspension of OAT after successful AF ablation ? even in patients at moderatehigh risk of TE. This conclusion needs to be confirmed by future large randomized ? trials. (J Am Coll Cardiol 2020。 2020 by the American College of Cardiology Foundation 房顫導(dǎo)管消融成功后，隨訪無(wú)房顫復(fù)發(fā)證據(jù)，然而栓塞事件未見(jiàn)明顯降低。 ACCORD Study Group. N E gl J Med, 2020. 辛伐他汀 2040mg* + 安慰劑 辛伐他汀 2040mg* + 非諾貝特 54160mg *根據(jù)患者 LDLC水平和心血管疾病史調(diào)整劑量 辛伐他汀聯(lián)用非諾貝特治療和單用辛伐 他汀治療不良事件的發(fā)生結(jié)果相似 加用非諾貝特治療沒(méi)有增加辛伐他汀發(fā)生 肌病，靜脈血栓癥或胰腺炎中任何一項(xiàng)疾 病風(fēng)險(xiǎn) 辛伐他汀聯(lián)用非諾貝特治療，較單用辛伐 他汀發(fā)生全因死亡和心血管死亡的患者無(wú)統(tǒng) 計(jì)學(xué)意義 安全性好 ACCORD血脂試驗(yàn)結(jié)論：辛伐他汀聯(lián)用非諾貝特治療安全性好 0 1 2 3 4 Years of followup 0 5 10 15 20 Patients suffering events (%) % % 安慰劑 ERN/LRPT Logrank P= Risk ratio (95% CI – ) HPS2THRIVE結(jié)果：對(duì)主要 心血管事件的影響 ? 研究的主要終點(diǎn)是冠心病死亡、非致死性心肌梗死、卒中或冠狀動(dòng)脈血運(yùn)重建，在對(duì)照組是%，在煙酸組是%，沒(méi)有統(tǒng)計(jì)學(xué)差異。 ● 殘余風(fēng)險(xiǎn)目前定義不確切；量化指標(biāo)難以確定；干預(yù)盲目 ● 確實(shí)存在；避免 “ 雙重風(fēng)險(xiǎn) /疊加風(fēng)險(xiǎn) ” Thank for your attention
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