sabato 10 marzo 2007

PTCA primaria nelle sindromi coronariche acute a ST non sopraslivellato ( NSTEMI)



Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study
Hirsch A, Windhausen F, Tijssen JG, Verheugt FW, Cornel JH, de Winter RJ, for the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) investigators
Lancet, 2007,Volume 369 issue 9564

Questo interessante studio pubblicato sull'ultimo numero del Lancet rilancia il problema dell'evidenza di benefici nel trattamento invasivo della sindrome coronarica acuta a ST sottoslivellato. Lo studio a lungo termine di 1200 pazienti (ST sottoslivellato e aumento della troponina) non ha evidenziato differenze nella mortalità tra un trattamento precoce invasivo (PTCA) e un trattamento precoce meno aggressivo (terapia medica e eventuale PTCA solo in caso di instabilità emodinamica).
Dopo tre anni i tre endpoint (mortalità, reIMA o riospedalizzazione per angina) erano simili nei due gruppi.
L'editoriale allegato conclude però per la presenza , malgrado tutto, di maggiori evidenze a favore di un trattamento aggressivo


Evidence Unclear on Treatment for Non-ST-Elevated Acute Coronary Syndrome

Long-term follow-up of patients with non-ST-elevation acute coronary syndrome (nSTE-ACS) showed no difference in mortality between more and less aggressive early treatments.
Researchers randomized 1200 nSTE-ACS patients with elevated cardiac troponin to early invasive treatment (immediate angiography followed when appropriate by percutaneous revascularization or cardiac surgery) or to selective invasive treatment (medical management only to start, with invasive procedures used in the event of cardiac instability). After 3 years, the combined primary endpoint of death, recurrent MI, or rehospitalization for angina did not differ between the two groups. MI was significantly more frequent with the early invasive strategy (an effect due to procedure-related MIs). There was no difference between the groups at the 4-year mark in all-cause mortality or cardiovascular mortality.

However, an editorialist argues that the available randomized trials "collectively show a significant improvement ... in patients with nSTE-ACS treated invasively rather than conservatively."



有非街晋升敏锐冠状的综合病症 ( nSTE-ACS ) 的病人的长期后续没有在更和不那么具竞争性早期治疗之间的死亡率中显示差异。

Seguimiento a largo plazo de pacientes con no SAN elevación síndrome agudo de coronario (nSTE-C.A.) no mostró diferencia en la mortalidad entre más y los tratamientos tempranos menos agresivos.

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