Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Iannaccone Mario, D Ascenzo Fabrizio, De Filippo Ovidio, Gagliardi Marco, Southern Danielle A, Raposeiras-Roubín Sergio, Abu-Assi Emad, Henriques Jose Paulo Simao, Saucedo Jorge, González-Juanatey José Ramón, Wilton Stephen B, Kikkert Wouter J, Nuñez-Gil Iván, Ariza-Sole Albert, Song Xiantao, Alexopoulos Dimitrios, Liebetrau Christoph, Kawaji Tetsuma, Huczek Zenon, Nie Shao-Ping, Fujii Toshiharu, Correia Luis, Kawashiri Masa-Aki, García-Acuña José María, Alfonso Emilio, Terol Belén, Garay Alberto, Zhang Dongfeng, Chen Yalei, Xanthopoulou Ioanna, Osman Neriman, Möllmann Helge, Shiomi Hiroki, Kowara Michal, Filipiak Krzysztof, Wang Xiao, Yan Yan, Fan Jing-Yao, Ikari Yuji, Nakahashi Takuya, Sakata Kenji, Yamagishi Masakazu, Moretti Claudio, Gaita Fiorenzo, Kalpak Oliver, Kedev Sasko
Аннотация
METHODS AND RESULTS: The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23-0.61; p < 0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55-1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83-2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1-0.4; log-rank p < 0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01).
CONCLUSION: In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs. (Clinical trials identifier: NCT02466854).