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Initial Invasive or...
Initial Invasive or Conservative Strategy for Stable Coronary Disease
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- Maron, David J. (författare)
- Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA.
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- Hochman, Judith S. (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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- Reynolds, Harmony R. (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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visa fler...
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- Bangalore, Sripal (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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- O'Brien, Sean M. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Boden, William E. (författare)
- Vet Affairs VA New England Healthcare Syst, Boston, MA USA.;Boston Univ, Sch Med, Boston, MA 02118 USA.
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- Chaitman, Bernard R. (författare)
- St Louis Univ, Sch Med, St Louis, MO 63103 USA.
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- Senior, Roxy (författare)
- Northwick Pk Hosp & Clin Res Ctr, London, England.;Imperial Coll London, London, England.;Royal Brompton Hosp, London, England.
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- Lopez-Sendon, Jose (författare)
- Hosp Univ La Paz, Inst Invest La Paz, Ctr Invest Biomed Red Cardiovasc, Madrid, Spain.
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- Alexander, Karen P. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Lopes, Renato D. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Shaw, Leslee J. (författare)
- Weill Cornell Med New York Presbyterian Hosp, New York, NY USA.
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- Berger, Jeffrey S. (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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- Newman, Jonathan D. (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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- Sidhu, Mandeep S. (författare)
- Albany Med Coll, Albany, NY 12208 USA.;Albany Med Ctr, Albany, NY USA.
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- Goodman, Shaun G. (författare)
- Univ Toronto, Canadian Heart Res Ctr, Toronto, ON, Canada.;Univ Toronto, St Michaels Hosp, Toronto, ON, Canada.
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- Ruzyllo, Witold (författare)
- Natl Inst Cardiol, Warsaw, Poland.
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- Gosselin, Gilbert (författare)
- Montreal Heart Inst, Res Ctr, Montreal, PQ, Canada.
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- Maggioni, Aldo P. (författare)
- Assoc Nazl Med Cardiol Osped, Florence, Italy.
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- White, Harvey D. (författare)
- Auckland Hosp Green Lane Cardiovasc Serv, Auckland, New Zealand.
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- Bhargava, Balram (författare)
- All India Inst Med Sci, New Delhi, India.
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- Min, James K. (författare)
- Cleerly, New York, NY USA.
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- Mancini, G. B. John (författare)
- Univ British Columbia, Vancouver, BC, Canada.
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- Berman, Daniel S. (författare)
- Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA.
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- Picard, Michael H. (författare)
- Massachusetts Gen Hosp, Boston, MA 02114 USA.;Harvard Med Sch, Boston, MA 02115 USA.
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- Kwong, Raymond Y. (författare)
- Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.
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- Ali, Ziad A. (författare)
- 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.
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- Mark, Daniel B. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Spertus, John A. (författare)
- St Lukes Mid Amer Heart Inst, Kansas City, MO USA.;Univ Missouri, Sch Med, Kansas City, MO 64108 USA.
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- Krishnan, Mangalath N. (författare)
- Govt Med Coll Kozhikode, Kozhikode, Kerala, India.
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- Elghamaz, Ahmed (författare)
- Northwick Pk Hosp & Clin Res Ctr, London, England.
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- Moorthy, Nagaraja (författare)
- Sri Jayadeva Inst Cardiovasc Sci & Res, Bangalore, Karnataka, India.
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- Hueb, Whady A. (författare)
- Univ Sao Paulo, Hosp Clin, Fac Med, Inst Coracao, Sao Paulo, Brazil.
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- Demkow, Marcin (författare)
- Natl Inst Cardiol, Dept Coronary & Struct Heart Dis, Warsaw, Poland.;Natl Inst Cardiol, Warsaw, Poland.
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- Mavromatis, Kreton (författare)
- Emory Univ, Sch Med, Atlanta VA Med Ctr, Decatur, GA 30033 USA.
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- Bockeria, Olga (författare)
- Natl Res Ctr Cardiovasc Surg, Moscow, Russia.
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- Peteiro, Jesus (författare)
- Complejo Hosp Univ A Coruna, Ctr Invest Biomed Red Cardiovasc, La Coruna, Spain.
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- Miller, Todd D. (författare)
- Mayo Clin, Rochester, MN USA.
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- Szwed, Hanna (författare)
- Natl Inst Cardiol, Warsaw, Poland.
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- Doerr, Rolf (författare)
- Praxisklin Herz & Gefaesse, Dresden, Germany.
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- Keltai, Matyas (författare)
- Semmelweis Univ, Budapest, Hungary.
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- Selvanayagam, Joseph B. (författare)
- Flinders Univ S Australia, Flinders Med Ctr, Adelaide, SA, Australia.
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- Steg, P. Gabriel (författare)
- Univ Paris, AP HP, Paris, France.;INSERM, U1148, Paris, France.
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- Held, Claes, 1956- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
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- Kohsaka, Shun (författare)
- Keio Univ, Sch Med, Shinjuku Ku, Tokyo, Japan.
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- Mavromichalis, Stavroula (författare)
- NYU, Grossman Sch Med, New York, NY USA.
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- Kirby, Ruth (författare)
- NIH, Bldg 10, Bethesda, MD 20892 USA.
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- Jeffries, Neal O. (författare)
- NIH, Bldg 10, Bethesda, MD 20892 USA.
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- Harrell, Frank E., Jr. (författare)
- Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA.
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- Rockhold, Frank W. (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Broderick, Samuel (författare)
- Duke Clin Res Inst, Durham, NC USA.
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- Ferguson, T. Bruce, Jr. (författare)
- East Carolina Univ, Brody Sch Med, Greenville, NC 27858 USA.
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- Williams, David O. (författare)
- Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.
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- Harrington, Robert A. (författare)
- Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA.
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- Stone, Gregg W. (författare)
- Cardiovasc Res Fdn, New York, NY USA.;Icahn Sch Med Mt Sinai, New York, NY 10029 USA.
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- Rosenberg, Yves (författare)
- NIH, Bldg 10, Bethesda, MD 20892 USA.
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- Eggers, Kai M., 1962- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),ISCHEMIA Research Group
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- Johnston, Nina, 1961- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),ISCHEMIA Research Group
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- Soveri, Inga (författare)
- Uppsala universitet,Njurmedicin,ISCHEMIA Research Group
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Stanford Univ, Sch Med, Dept Med, 1265 Welch Rd,Med Sch Off Bldg x314, Stanford, CA 94305 USA NYU, Grossman Sch Med, New York, NY USA. (creator_code:org_t)
- 2020
- 2020
- Engelska.
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Ingår i: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 382:15, s. 1395-1407
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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Maron, David J.
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Hochman, Judith ...
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Reynolds, Harmon ...
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Bangalore, Sripa ...
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O'Brien, Sean M.
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Boden, William E ...
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visa fler...
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Chaitman, Bernar ...
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Senior, Roxy
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Lopez-Sendon, Jo ...
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Alexander, Karen ...
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Lopes, Renato D.
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Shaw, Leslee J.
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Berger, Jeffrey ...
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Newman, Jonathan ...
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Sidhu, Mandeep S ...
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Goodman, Shaun G ...
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Ruzyllo, Witold
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Gosselin, Gilber ...
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Maggioni, Aldo P ...
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White, Harvey D.
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Bhargava, Balram
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Min, James K.
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Mancini, G. B. J ...
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Berman, Daniel S ...
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Picard, Michael ...
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Kwong, Raymond Y ...
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Ali, Ziad A.
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Mark, Daniel B.
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Spertus, John A.
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Krishnan, Mangal ...
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Elghamaz, Ahmed
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Moorthy, Nagaraj ...
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Hueb, Whady A.
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Demkow, Marcin
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Mavromatis, Kret ...
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Bockeria, Olga
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Peteiro, Jesus
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Miller, Todd D.
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Szwed, Hanna
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Doerr, Rolf
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Keltai, Matyas
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Selvanayagam, Jo ...
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Steg, P. Gabriel
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Held, Claes, 195 ...
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Kohsaka, Shun
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Mavromichalis, S ...
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Kirby, Ruth
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Jeffries, Neal O ...
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Harrell, Frank E ...
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Rockhold, Frank ...
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Broderick, Samue ...
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Ferguson, T. Bru ...
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Williams, David ...
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Harrington, Robe ...
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Stone, Gregg W.
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Rosenberg, Yves
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Eggers, Kai M., ...
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Johnston, Nina, ...
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Soveri, Inga
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New England Jour ...
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