I-COURAGE inselele yokucwaninga ukusetshenziswa kwe-stents kwiziguli ze-CAD ezizinzile
Ukusetshenziswa kwesimiso ngezigulane ezigulini ezine- stonary artery disease (i-CAD) inselele kakhulu ekuvivinyweni kwe-COURAGE, okwabikwa okokuqala ngo-2007. Kulesi sivivinyo, iziguli ezine-CAD ezizinzile zazingakahleleki ukuthola ukwelashwa okungcono kokwelashwa yedwa noma ukwelashwa okunezokwelapha okuhle kanye ama-stents. Ucwaningo alukho umehluko emiphumeleni phakathi kwamaqembu amabili emva kweminyaka engu-4.6.
Ukumelana Nemiphumela ye-COURAGE Trial
Imiphumela yesilingo se-COURAGE kufanele ukuthi yonke i-cardiologists ihlole kabusha uma isebenzisa ama-stents nokuthi iziphi iziguli. Kodwa izazi eziningi ze-cardiologists azizange zishintshe imikhuba yazo mayelana nezitshalo. Umqondo wabo wukuthi abaningi bakholelwa ukuthi ukuvulwa kwama-stentika nge-stents kuvele kusebenze kakhudlwana kunezokwelapha zokwelapha ekuvimbeleni ukuhlaselwa kwenhliziyo nokufa. Ngakho-ke, imiphumela evela ku-COURAGE kumele ibe yiphutha. Babekholelwa ukuthi kungenzeka ukuthi ukulandelwa kwesikhathi eside kuzodalula iqiniso.
Kodwa ngo-November 2015, imiphumela yokugcina yesikhathi eside ye-COURAGE ishicilelwe. Ngemuva kweminyaka engaba ngu-12 yokulandelela, ama-stents ayengabani nanzuzo ngalutho lwezokwelapha ezifanele.
Imininingwane ye-COURAGE Trial
Ekulingweni kwe-COURAGE, iziguli ezingu-2,287 ezine-CAD ezizinzile ("ezizinzile" ze-CAD zisho ukuthi i-coronary syndrome enzima ayitholakali) yayingakahleleki ukuthola i-medicinal treatment kuphela noma imithi yokwelapha efanele kanye nama-stents.
Isigameko sokuhlaselwa kwenhliziyo kanye nokufa kwezinhliziyo esilandelayo saboniswa.
Kwakungekho umehluko emiphakathini phakathi kwamaqembu. Nokho, iziguli ezithola ama-stents zenza ukulawula kangcono izimpawu zabo ze-angina kuneziguli ezithinta ukwelapha izidakamizwa zodwa, kodwa ingozi yabo yokuhlasela kwenhliziyo nokufa akuzange kuthuthukiswe.
Ukuhlaziywa kokulandelwa kuka-2015 kubheka ukungezwani kokufa kwesikhathi eside phakathi kwamaqembu amabili. Ngemva kweminyaka eyi-11,9, kwakungekho umehluko ophawulekayo. Amaphesenti angamashumi amabili nesishiyagalolunye weziguli ezithola ama-stents eshonile, uma kuqhathaniswa namaphesenti angu-24 eziguli eziphathwe ukwelashwa ngokweqile.
Abaphenyi babheka izingxenyana eziningi zeziguli ukuze babone ukuthi ngabe enye i-subset kungenzeka isenze kangcono nge-stents. Abatholanga lutho olwenzile.
Kufanele Kusetshenziswe Nini Iziqu?
Manje kubonakala kucacile ukuthi ama-stents akufanele asetshenziswe njengendlela yokwelashwa kokuqala emkhakheni we-CAD ozinzile ukuvimbela ukuhlaselwa kwenhliziyo ngoba ama-stents awaphumelelanga kakhulu ekuvimbeleni ukuhlaselwa kwenhliziyo kulesi simo kunokwethenjelwa okwelashwa okulungile. Eqinisweni, kunombuzo wangempela mayelana nokuthi kukhona ama-stents angakanani okuwusizo nhlobo ekuphatheni ama-angina azinzile .
Ama-stents kufanele asetshenziswe , ku-CAD esinqabile, kuphela uma i-angina ephawulekayo isenzeka naphezu kokwelashwa okulungile kwezokwelapha.
I-COURAGE Imiphumela ingachazwa kanjani?
Imiphumela yesilingo se-COURAGE iyahambisana nokucabanga okusha ku-CAD nokuthi ukuhlasela kwenhliziyo kwenzeka kanjani. Ukuhlaselwa kwenhliziyo akubangelwa i- plaque ezinzile ekhula kancane kancane ukuze ivimbele umshini. Esikhundleni salokho, kubangelwa i-plaque ephuka kancane, ngaleyo ndlela kubangelwa ukwakheka okungazelelwe kwe-blood clot ngaphakathi kwe-artery, okuyinto ngokuzenzakalelayo ivimba umthambo.
Ukukhwabanisa nokuvala i-clotting cishe kunokwenzeka nje ukuthi kwenzeke ku-plaque evimbela amaphesenti ayishumi kuphela omthamo njengaleyo evimbela amaphesenti angu-80.
Ukugxila "amakhemikhali" abalulekile kuzosiza ukukhulula noma yikuphi ukungena okubangelwa ukuvimba ngokwayo. Kodwa, ngokusobala, ngeke kuncishiswe ingozi yokuhlaselwa kwenhliziyo-ikakhulukazi ngoba eziningi zalezi zifo zenhliziyo zihlotshaniswa namacwecwe abacwaningi be-cardiologists ngokuvamile ababiza ngokuthi "awubalulekile."
Ukuvimbela ukuhlukumeza okukhulu kwamacwecwe, futhi ngaleyo ndlela kuvimbele ukuhlaselwa kwenhliziyo, kubheka nokuningi njengenkinga yezokwelapha kunokuba "inkinga yokubheja." Kungcono ukwelashwa ngezidakamizwa kanye nezinguquko zokuphila .
"Ukuqinisa" amakhemikhali omzimba (okwenza kube lula ukuphuka) kudinga ukulawula okunonya kwe-cholesterol, ukucindezelwa kwegazi nokuvuvukala. Kudinga futhi ukuzivocavoca njalo futhi kwenzeke kancane kancane. Ukwelashwa kwezidakamizwa ezinonya kuzokufaka i-aspirin, izitembu, izivimbela ze-beta, kanye nemithi yegazi (uma kudingekile).
Uma une-CAD ezinzile- noma ngabe i-stent iyadingeka yini ukuphatha i-angina yakho-ukuvimbela ngempela ukuhlaselwa kwenhliziyo kuzodingeka ube kulolu cwaningo lwezokwelapha olubudlova. Kufanele uqiniseke ukuthi uxoxe nodokotela wakho we-cardiologist okwakungenza ukwelapha okunezokwelapha okulungile kuwe.
> Imithombo:
> Boden WE, O'Rourke RA, Teo KK, et al. Ukwelapha okwelashwa okuqondile noma ngaphandle kwe-PCI yesifo esiqinile esine-coronary disease. N Engl J Med 2007; I-DOI: 10.1056 / NEJMe070829.
> Borden WB, Redberg RF, Mushlin AI, et al. Amaphethini nokuqina kwelashwa yezokwelapha ezigulini ezithintekayo ekungeneni kwe-coronary. I-JAMA 2011; 305: 1882-1889.
> Sedlis SP, i-Hartigan PM, i-Teo KK, et al. Imiphumela ye-PCI ekuPhephekeni Kwesikhathi eside Kwabagulayo abaneSifo Esiqinile Sase-Ischemic Heart. I-New England Journal of Medicine . 2015; 373 (20): 1937-1946. doi: 10.1056 / nejmoa1505532.