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Sökning: onr:"swepub:oai:DiVA.org:uu-411466" > Initial Invasive or...

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FältnamnIndikatorerMetadata
00009756naa a2200973 4500
001oai:DiVA.org:uu-411466
003SwePub
008200605s2020 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4114662 URI
0247 a https://doi.org/10.1056/NEJMoa19159222 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Maron, David J.u Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA.4 aut
2451 0a Initial Invasive or Conservative Strategy for Stable Coronary Disease
264 1c 2020
338 a print2 rdacarrier
520 a Background: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain.Methods: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction.Results: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).Conclusions: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, .) Patients with stable coronary disease were randomly assigned to an initial invasive strategy with angiography and revascularization if appropriate or to medical therapy alone. At 3.2 years, there was no significant difference between the groups with respect to the estimated rate of ischemic events. The findings were sensitive to the definition of myocardial infarction.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
7001 a Hochman, Judith S.u NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a Reynolds, Harmony R.u NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a Bangalore, Sripalu NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a O'Brien, Sean M.u Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Boden, William E.u Vet Affairs VA New England Healthcare Syst, Boston, MA USA.;Boston Univ, Sch Med, Boston, MA 02118 USA.4 aut
7001 a Chaitman, Bernard R.u St Louis Univ, Sch Med, St Louis, MO 63103 USA.4 aut
7001 a Senior, Roxyu Northwick Pk Hosp & Clin Res Ctr, London, England.;Imperial Coll London, London, England.;Royal Brompton Hosp, London, England.4 aut
7001 a Lopez-Sendon, Joseu Hosp Univ La Paz, Inst Invest La Paz, Ctr Invest Biomed Red Cardiovasc, Madrid, Spain.4 aut
7001 a Alexander, Karen P.u Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Lopes, Renato D.u Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Shaw, Leslee J.u Weill Cornell Med New York Presbyterian Hosp, New York, NY USA.4 aut
7001 a Berger, Jeffrey S.u NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a Newman, Jonathan D.u NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a Sidhu, Mandeep S.u Albany Med Coll, Albany, NY 12208 USA.;Albany Med Ctr, Albany, NY USA.4 aut
7001 a Goodman, Shaun G.u Univ Toronto, Canadian Heart Res Ctr, Toronto, ON, Canada.;Univ Toronto, St Michaels Hosp, Toronto, ON, Canada.4 aut
7001 a Ruzyllo, Witoldu Natl Inst Cardiol, Warsaw, Poland.4 aut
7001 a Gosselin, Gilbertu Montreal Heart Inst, Res Ctr, Montreal, PQ, Canada.4 aut
7001 a Maggioni, Aldo P.u Assoc Nazl Med Cardiol Osped, Florence, Italy.4 aut
7001 a White, Harvey D.u Auckland Hosp Green Lane Cardiovasc Serv, Auckland, New Zealand.4 aut
7001 a Bhargava, Balramu All India Inst Med Sci, New Delhi, India.4 aut
7001 a Min, James K.u Cleerly, New York, NY USA.4 aut
7001 a Mancini, G. B. Johnu Univ British Columbia, Vancouver, BC, Canada.4 aut
7001 a Berman, Daniel S.u Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA.4 aut
7001 a Picard, Michael H.u Massachusetts Gen Hosp, Boston, MA 02114 USA.;Harvard Med Sch, Boston, MA 02115 USA.4 aut
7001 a Kwong, Raymond Y.u Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.4 aut
7001 a Ali, Ziad A.u Cardiovasc Res Fdn, New York, NY USA.;Columbia Univ, Irving Med Ctr, New York Presbyterian Hosp, New York, NY USA.;St Francis Hosp, Roslyn, NY USA.4 aut
7001 a Mark, Daniel B.u Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Spertus, John A.u St Lukes Mid Amer Heart Inst, Kansas City, MO USA.;Univ Missouri, Sch Med, Kansas City, MO 64108 USA.4 aut
7001 a Krishnan, Mangalath N.u Govt Med Coll Kozhikode, Kozhikode, Kerala, India.4 aut
7001 a Elghamaz, Ahmedu Northwick Pk Hosp & Clin Res Ctr, London, England.4 aut
7001 a Moorthy, Nagarajau Sri Jayadeva Inst Cardiovasc Sci & Res, Bangalore, Karnataka, India.4 aut
7001 a Hueb, Whady A.u Univ Sao Paulo, Hosp Clin, Fac Med, Inst Coracao, Sao Paulo, Brazil.4 aut
7001 a Demkow, Marcinu Natl Inst Cardiol, Dept Coronary & Struct Heart Dis, Warsaw, Poland.;Natl Inst Cardiol, Warsaw, Poland.4 aut
7001 a Mavromatis, Kretonu Emory Univ, Sch Med, Atlanta VA Med Ctr, Decatur, GA 30033 USA.4 aut
7001 a Bockeria, Olgau Natl Res Ctr Cardiovasc Surg, Moscow, Russia.4 aut
7001 a Peteiro, Jesusu Complejo Hosp Univ A Coruna, Ctr Invest Biomed Red Cardiovasc, La Coruna, Spain.4 aut
7001 a Miller, Todd D.u Mayo Clin, Rochester, MN USA.4 aut
7001 a Szwed, Hannau Natl Inst Cardiol, Warsaw, Poland.4 aut
7001 a Doerr, Rolfu Praxisklin Herz & Gefaesse, Dresden, Germany.4 aut
7001 a Keltai, Matyasu Semmelweis Univ, Budapest, Hungary.4 aut
7001 a Selvanayagam, Joseph B.u Flinders Univ S Australia, Flinders Med Ctr, Adelaide, SA, Australia.4 aut
7001 a Steg, P. Gabrielu Univ Paris, AP HP, Paris, France.;INSERM, U1148, Paris, France.4 aut
7001 a Held, Claes,d 1956-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi4 aut0 (Swepub:uu)clahe947
7001 a Kohsaka, Shunu Keio Univ, Sch Med, Shinjuku Ku, Tokyo, Japan.4 aut
7001 a Mavromichalis, Stavroulau NYU, Grossman Sch Med, New York, NY USA.4 aut
7001 a Kirby, Ruthu NIH, Bldg 10, Bethesda, MD 20892 USA.4 aut
7001 a Jeffries, Neal O.u NIH, Bldg 10, Bethesda, MD 20892 USA.4 aut
7001 a Harrell, Frank E., Jr.u Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA.4 aut
7001 a Rockhold, Frank W.u Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Broderick, Samuelu Duke Clin Res Inst, Durham, NC USA.4 aut
7001 a Ferguson, T. Bruce, Jr.u East Carolina Univ, Brody Sch Med, Greenville, NC 27858 USA.4 aut
7001 a Williams, David O.u Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.4 aut
7001 a Harrington, Robert A.u Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA.4 aut
7001 a Stone, Gregg W.u Cardiovasc Res Fdn, New York, NY USA.;Icahn Sch Med Mt Sinai, New York, NY 10029 USA.4 aut
7001 a Rosenberg, Yvesu NIH, Bldg 10, Bethesda, MD 20892 USA.4 aut
7001 a Eggers, Kai M.,d 1962-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),ISCHEMIA Research Group0 (Swepub:uu)kaieg561
7001 a Johnston, Nina,d 1961-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),ISCHEMIA Research Group0 (Swepub:uu)ninjo389
7001 a Soveri, Ingau Uppsala universitet,Njurmedicin,ISCHEMIA Research Group0 (Swepub:uu)insov254
7102 a Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA.b NYU, Grossman Sch Med, New York, NY USA.4 org
7730 t New England Journal of Medicineg 382:15, s. 1395-1407q 382:15<1395-1407x 0028-4793x 1533-4406
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-411466
8564 8u https://doi.org/10.1056/NEJMoa1915922

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