對(duì)于心臟病，藥物可能與侵入性手術(shù)一樣有效

對(duì)于心臟病，藥物可能與侵入性手術(shù)一樣有效

High-risk patients with stable heart disease may fare just as well on medications alone, versus having invasive heart operations such as stents and bypass surgeries, according to a major trial. The results were presented Saturday at the American Heart Association's yearly conference.

一項(xiàng)大型試驗(yàn)顯示，與接受支架和搭橋手術(shù)等侵入性心臟手術(shù)相比，患有穩(wěn)定心臟病的高風(fēng)險(xiǎn)患者僅接受藥物治療可能效果一樣好。研究結(jié)果于周六在美國(guó)心臟協(xié)會(huì)的年度會(huì)議上公布。

While the invasive procedures were found to improve chest pain and quality of life in some patients, a number of key outcomes did not differ significantly -- namely, subsequent heart attack, hospitalization for unstable chest pain or heart failure, resuscitation after cardiac arrest and death from cardiovascular causes.

雖然發(fā)現(xiàn)侵入性手術(shù)可以改善一些患者的胸痛和生活質(zhì)量，但一些關(guān)鍵結(jié)果并沒(méi)有顯著差異-即隨后的心臟病發(fā)作、因不穩(wěn)定的胸痛或心力衰竭而住院、心臟驟停后的復(fù)蘇和心血管疾病引起的死亡。

"Patients want to know, is this treatment going to make me live longer?" said study chair Dr. Judith Hochman, senior associate dean for clinical sciences at NYU Langone Health. "Based on what we saw, we did not see evidence that would make them live longer."

“病人想知道，這種治療是否會(huì)讓我活得更長(zhǎng)？”研究主席朱迪恩郝赤曼博士說(shuō)，他是紐約大學(xué)朗格尼健康學(xué)院負(fù)責(zé)臨床科學(xué)的高級(jí)副院長(zhǎng)。“根據(jù)我們看到的情況，我們沒(méi)有看到能讓他們活得更長(zhǎng)的證據(jù)。”

Stents and bypass surgeries are commonly used for patients with heart attack, but whether to intervene with patients who are stable -- who have blockages or chest pain during exercise, but not an acute heart attack -- has been hotly debated.

支架和搭橋手術(shù)通常用于心臟病發(fā)作的患者，但是否對(duì)病情穩(wěn)定的患者(在運(yùn)動(dòng)過(guò)程中有阻塞或胸痛，但不是急性心臟病發(fā)作)進(jìn)行干預(yù)一直存在激烈的爭(zhēng)論。

Patients having a heart attack were not included in the study, nor were other groups, including those with poor heart muscle function or those with narrowing of the heart's main coronary artery.

心臟病發(fā)作的患者不包括在這項(xiàng)研究中，其他那些包括心肌功能差或心臟主冠狀動(dòng)脈狹窄的患者也不在研究范圍內(nèi)。

But when it came to patients with stable heart disease, "we selected patients with a very abnormal stress test," Hochman explained. "Is it was thought that if anybody is going to benefit from an invasive strategy of stenting or bypass surgery, those were the patients that would benefit."

但是當(dāng)涉及到穩(wěn)定的心臟病患者時(shí)，“我們選擇了壓力測(cè)試非常異常的患者，”郝赤曼解釋說(shuō)。“人們認(rèn)為，如果有人要從支架植入或搭橋手術(shù)的侵入性策略中受益，那么這些患者就會(huì)受益。”

The international trial, which launched in 2012, included more than 5,000 patients in 37 countries, making it the largest study of its kind, the researchers said. Hochman said it builds on two earlier studies that made similar conclusions but, in part due to how they were designed, failed to gain wider acceptance among doctors.

研究人員表示，2012年啟動(dòng)的這項(xiàng)國(guó)際試驗(yàn)，涵蓋了37個(gè)國(guó)家的5000多名患者，是同類(lèi)研究中規(guī)模最大的一次。郝赤曼說(shuō)，該研究建立在兩項(xiàng)早期研究的基礎(chǔ)上，這兩項(xiàng)研究得出了類(lèi)似的結(jié)論，但由于它們的設(shè)計(jì)方式，未能得到醫(yī)生的廣泛認(rèn)可。

If asymptomatic patients forgo invasive therapies, Hochman estimates the savings could be in the hundreds of millions of dollars in the United States, based on earlier research.

郝赤曼根據(jù)早期的研究估計(jì)，如果無(wú)癥狀患者放棄侵入性治療，在美國(guó)可節(jié)省數(shù)億美元。

"The implications are quite large globally and in the United States," she said.

“其影響在全球和美國(guó)都相當(dāng)大，”她說(shuō)。