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#1
02.04.2007, 10:06
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Разная тактика при ИБС
Очередное исследование, сравнивающее различные лечебные подходы при стабильной стенокардии и многососудистом поражении.
АКШ рулит... К сожалению мне недоступен полный текст. Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease. [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ], [Ссылки доступны только зарегистрированным пользователям ]. BACKGROUND: Despite routine use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), no conclusive evidence exists that either modality is superior to medical therapy (MT) alone for treating multivessel coronary artery disease with stable angina and preserved ventricular function. METHODS AND RESULTS: The primary end points were total mortality, Q-wave myocardial infarction, or refractory angina requiring revascularization. The study comprised 611 patients randomly assigned to undergo CABG (n=203), PCI (n=205), or MT (n=203). At the 5-year follow-up, the primary end points occurred in 21.2% of patients who underwent CABG compared with 32.7% treated with PCI and 36% receiving MT alone (P=0.0026). No statistical differences were observed in overall mortality among the 3 groups. In addition, 9.4% of MT and 11.2% of PCI patients underwent repeat revascularization procedures compared with 3.9% of CABG patients (P=0.021). Moreover, 15.3%, 11.2%, and 8.3% of patients experienced nonfatal myocardial infarction in the MT, PCI, and CABG groups, respectively (P<0.001). The pairwise treatment comparisons of the primary end points showed no difference between PCI and MT (relative risk, 0.93; 95% confidence interval, 0.67 to 1.30) and a significant protective effect of CABG compared with MT (relative risk, 0.53; 95% confidence interval, 0.36 to 0.77). CONCLUSIONS: All 3 treatment regimens yielded comparable, relatively low rates of death. MT was associated with an incidence of long-term events and rate of additional revascularization similar to those for PCI. CABG was superior to MT in terms of the primary end points, reaching a significant 44% reduction in primary end points at the 5-year follow-up of patients with stable multivessel coronary artery disease. 
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#2
02.04.2007, 11:29
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Сообщение от 15-03-2007, 11:58 Картинки-буратинки
Цитата:
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#5
03.05.2007, 12:45
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CABG vs PCI
Omer Aziz et al "Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery" BMJ 2007;334:617-21
ABSTRACT Objective To compare outcomes between minimally invasive left internal thoracic artery bypass and percutaneous coronary artery stenting as primary interventions for isolated lesions of the left anterior descending artery. Design Meta-analysis of randomised and nonrandomised comparative peer reviewed publications. Data sources Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005). Review methods Studies comparing the two procedures as the primary intervention for isolated left anterior descending artery stenosis were identified and the following extracted: study design, population characteristics, severity of coronary artery disease, cardiovascular risk factors, and outcomes of interest. Results 12 studies (1952 patients) reporting results from eight groups were included: one was a retrospective design, one prospective non-randomised, and six prospective randomised. Meta-analysis of randomised trials showed a higher rate of recurrence of angina (odds ratio 2.62, 95% confidence interval 1.32 to 5.21), incidence of major adverse coronary and cerebral events (2.86, 1.62 to 5.08), and need for repeat revascularisation (4.63, 2.52 to 8.51) with percutaneous stenting. No significant difference was found in myocardial infarction, stroke, or mortality at maximum follow-up between interventions. Conclusions Minimally invasive left internal thoracic artery bypass for isolated lesions of the left anterior descending artery resulted in fewer complications in the mid-term compared with percutaneous transluminal coronary artery stenting. [Ссылки доступны только зарегистрированным пользователям ]
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#6
03.05.2007, 14:06
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CABG vs PCI
"Злые" языки утверждают, что АКШ дороже ТБКА.
В этом же номере BMJ Christopher Rao et al "Cost effectiveness analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery" ABSTRACT Objective To compare the cost effectiveness of percutaneous transluminal coronary artery stenting with minimally invasive internal thoracic artery bypass for isolated lesions of the left anterior descending artery. Design Cost effectiveness analysis. Data sources Embase, Medline, Cochrane, Google Scholar, and Health Technology Assessment databases (1966-2005), and reference sources for utility values and economical variables. Methods Decision analytical modelling and Markov simulation were used to model medium and long term costs, quality of life, and cost effectiveness after either intervention using data from referenced sources. Probabilistic sensitivity and alternative analyses were used to investigate the effect of uncertainty about the value of model variables and model structure. Results Stenting was the dominant strategy in the first two years, being both more effective and less costly than bypass surgery. In the third year bypass surgery still remained more expensive but became marginally more effective. As the incremental cost effectiveness was £1 108 130.40 (?1 682 146.00; $2 179 194) per quality adjusted life year (QALY), the additional effectiveness could not be said to justify the additional cost at this stage. By five years, however, the incremental cost effectiveness ratio of £28 042.95 per QALY began to compare favourably with other interventions. At 10 years the additional effectiveness of 0.132 QALYs (range −0.166 to 0.430) probably justified the additional cost of £829.02 (range £205.56 to £1452.48), with an incremental cost effectiveness of £6274.02 per QALY. Sensitivity and alternative analysis showed the results were sensitive to the time horizon and stent type. Conclusions Minimally invasive left internal thoracic artery bypass may be a more cost effective medium and long term alternative to percutaneous transluminal coronary artery stenting. [Ссылки доступны только зарегистрированным пользователям ]
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Линейный вид
