I-COURAGE yokufunda imingeni yokusetyenziswa kwezigulane kwizigulane ezizinzileyo zeCAD
Ukusetyenziswa kwesiqhelo kwezigulane kwizigulane ezinezifo zesifo se-coronary disease (CAD) sasinzima kakhulu kuvavanyo lweCOURAGE, lwabikwa okokuqala ngo-2007. Kule vavanyo, izigulane ezineCAD ezizinzileyo zazingenakulinganiswa ukuba zithole unyango olufanelekileyo lonyango okanye lonyango olufanelekileyo lonyango kunye i stents. Uhlolisiso alubonisi nomehluko kwiziphumo phakathi kwamaqela amabini emva kweminyaka engama-4.6.
Ukuchasiswa kwiZiphumo zeCOURAGE
Iziphumo zeetyala leCOURAGE kufuneka zenze zonke i-cardiologists zihlolisise xa zisebenzisa i-stents kunye nezigulane. Kodwa ezininzi zezinto ze-cardiologists azizange zitshintshe izenzo zabo malunga neentente. Ingqiqo yabo kukuba abaninzi babekholelwa ukuba ukuvulwa kwamathambo kunye namaqabunga kufuneka ukuba kube ngempumelelo kunokuba unyango lwezonyango lukhusele ukuhlaselwa kwentliziyo nokufa. Ngoko ke, iziphumo ezivela kwiCOURAGE kufuneka ziphosakele. Baye bakholelwa ukuba kwakunokwenzeka ukuba ukulandelelwa kwexesha elide kwakuza kubonakalisa inyaniso.
Kodwa ngoNovemba 2015, iziphumo zokugqibela zexesha elide zeCOURAGE zapapashwa. Emva kweminyaka engama-12 yokulandelelana, ama-stents ayengenaso inzuzo kwiyeza elithe ngqo.
Iinkcukacha zeCOURAGE Trial
Kwilingo le-COURAGE, izigulane ezingama-2,287 ezine-CAD ezizinzile ("ezizinzileyo" zeCAD zithetha ukuba i -coronary syndrome enzima ayifumaneki) yayingenakulinganiswa ukuba yifumane unyango olulodwa lonyango okanye unyango oluchanekileyo lwamachiza kunye neentente.
Iziganeko zokuhlaselwa kwintliziyo kunye nokufa kwabekwa.
Kwakungekho umahluko kwiziphumo phakathi kwamaqela. Kodwa izigulane ezithobela i-stents zenza ukuba zilunge kakuhle iimpawu zazo ze-angina kunezigulane zonyango lonyango kuphela, kodwa ingozi yabo yokuhlaselwa yintliziyo nokufa akuzange kuphuculwe.
Uhlalutyo olulandelayo lwango-2015 lwalujonga ukungafani kwexesha elide phakathi kwamaqela amabini. Emva komyinge wama-11.9 iminyaka, kwakungekho nto ephawulekayo. Amaphesenti amabini anesihlanu kwezigulane ezithola i-stents zafa, xa kuthelekiswa neepesenti ezingama-24 zezigulane eziphathwe ngonyango kuphela.
Abaphandi bajonga iinqununu ezininzi zegulane ukuze babone ukuba i-subset ingaba yenze ngcono kangakanani ngeentente. Akufumananga nantoni.
Xa Kufuneka Kusetshenziswe Isitebe?
Ngoku kubonakala kucacile ukuba ama-stents akufanele asetyenziswe njengonyango lokuqala kumgca we-CAD okhuselekileyo ukukhusela ukuhlaselwa kwintliziyo ngenxa yokuba i-stents ayinakusebenza ngakumbi ekukhuseleni ukuhlaselwa kwentliziyo kwimeko efanelekileyo kunonyango olululo lwezonyango. Enyanisweni, kukho umbuzo wangempela malunga nokuba zininzi kangakanani izilwanyana zincedo kuzo zonke ukunyanga i-angina .
Iimpawu kufuneka zisetyenziswe , kwi-CAD egciniweyo, kuphela xa i-angina ephawulekayo isenzeka nangona unyango olufanelekileyo lweyeza.
I-COURAGE Results ingachazwa njani?
Iziphumo zovavanyo lweCOURAGE ziyahambelana nokucinga okutsha kwi-CAD kunye nokuhlaselwa kwentliziyo. Ukuhlaselwa yintliziyo akubangelwa yiplani ezinzileyo ekhula ngokukhawuleza ukuvimba umzobo. Esikhundleni salokho, kubangelwa i-plaque ephuka ngokukhawuleza, ngaloo ndlela ibangela ukwakheka ngokukhawuleza kwegazi ngaphakathi kwe-artery, leyo leyo ibhaqa ngokukhawuleza i-artery.
Ukurhoxiswa kunye nokuvala i-clotting mhlawumbi kunokwenzeka ukuba kwenzeke kwi-plaque evimba kuphela iipesenti ezili-10 zetriyiti njengento evimbela ama-80 ekhulwini.
Ukugxininisa "iiplani" ezibalulekileyo kuya kunceda ekunciphiseni nayiphi na ingxaki ebangelwa kukuvalwa. Kodwa, ngokusobala, ayiyi kunciphisa ingozi yokuhlaselwa kwentliziyo-ikakhulukazi kuba ezinye zezi ntsholongwane zentliziyo zidibaniswa neentlanzi ezibizwa ngokuthi "cardiologist" ngokuqhelekileyo ngokuthi "azibalulekanga."
Ukuthintela ukuphuka kwamacwecwe, kwaye ngokuthintela ukuhlaselwa kweentliziyo, kukhangele ngakumbi kwaye kunjengeengxaki zonyango endaweni ye "ingxaki yokutywala." Ukuphathwa kakubi ngezilwanyana kunye neenguqu zokuphila .
"Ukuzinzisa" iipontiki zomzobo (okwenza ukuba bancitshiswe kangako) kufuna ukulawulwa ngomsindo we-cholesterol, uxinzelelo lwegazi kunye nokuvuvukala. Kwakudinga ukuba usebenze rhoqo kunye nokwenza i-clotting encinci. Ulwaphulo olunonyango lweziyobisi luya kubandakanya i-aspirin, i-statins, i-blocka blockers, kunye neyeza zonyango lwegazi (xa kuyimfuneko).
Ukuba unesigxina se-CAD- nokuba ingaba i-stent iyimfuneko ukunyanga i-angina-ekukhuseleni ngokwenene ukuhlaselwa kwentliziyo kuya kufuneka ukuba ube kulolu culo lonyango olunonya. Kufuneka uqiniseke ukuba uxoxe kunye ne-cardiologist yakho yintoni eya kuba yonyango elona lifanelekileyo kwiyeza lakho.
> Imithombo:
> Boden WE, ORourke RA, Teo KK, et al. Ulwaphulo oluchanekileyo lwezonyango kunye okanye ngaphandle kwe-PCI kwisifo se-coronary disease. N Engl J Med 2007; INGXELO: 10.1056 / NEJMe070829.
> IBorden WB, i-Redberg RF, iMushlin AI, et al. Iipatheni kunye nobukhulu beliyeza lonyango kwizigulana ezithatyathwa ngoncedo lwe-coronary. JAMA 2011; 305: 1882-1889.
> Sedlis SP, i-Hartigan PM, iTeo KK, et al. Impembelelo ye-PCI kwiSithuba esiSigxina kwixesha elide kwizigulane ezineSifo esiSisicic Heart Cisease. I-New England Journal of Medicine . 2015; 373 (20): 1937-1946. i-doi: 10.1056 / nejmoa1505532.