{"id":18000,"date":"2019-12-10T02:39:10","date_gmt":"2019-12-09T18:39:10","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18000"},"modified":"2019-12-24T05:45:40","modified_gmt":"2019-12-23T21:45:40","slug":"nejm%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9a%e6%97%a0%e7%97%87%e7%8a%b6%e4%b8%bb%e5%8a%a8%e8%84%89%e7%93%a3%e7%8b%ad%e7%aa%84%e6%82%a3%e8%80%85%e6%97%a9%e6%9c%9f%e6%89%8b%e6%9c%af%e4%b8%8e","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18000","title":{"rendered":"[NEJM\u5728\u7ebf\u53d1\u8868]\uff1a\u65e0\u75c7\u72b6\u4e3b\u52a8\u8109\u74e3\u72ed\u7a84\u60a3\u8005\u65e9\u671f\u624b\u672f\u4e0e\u4fdd\u5b88\u6cbb\u7597"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a> <\/strong>FREE PREVIEW<\/strong><\/p>\n\n\n\n

Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis<\/h1>\n\n\n\n

Duk-Hyun Kang, Sung-Ji Park, Seung-Ah Lee, et al<\/h3>\n\n\n\n

N Engl J Med November 16, 2019
DOI: 10.1056\/NEJMoa1912846<\/h3>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h3>\n\n\n\n

The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial.<\/p>\n\n\n\n

\u65e0\u75c7\u72b6\u7684\u4e25\u91cd\u4e3b\u52a8\u8109\u74e3\u72ed\u7a84\u60a3\u8005\u624b\u672f\u5e72\u9884\u7684\u65f6\u673a\u53ca\u9002\u5e94\u75c7\u5b58\u5728\u4e89\u8bae\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h3>\n\n\n\n

In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of \u22640.75 cm2<\/sup>\u00a0with either an aortic jet velocity of \u22654.5 m per second or a mean transaortic gradient of \u226550 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u591a\u4e2d\u5fc3\u7814\u7a76\u4e2d\uff0c\u6211\u4eec\u5c06145\u540d\u65e0\u75c7\u72b6\u7684\u4e25\u91cd\u4e3b\u52a8\u8109\u74e3\u72ed\u7a84(\u5b9a\u4e49\u4e3a\u4e3b\u52a8\u8109\u74e3\u73af\u9762\u79ef\u2264 0.75 cm2<\/sup>\u00a0\u4f34\u4e3b\u52a8\u8109\u6d41\u901f \u2265 4.5 m\/sec \u6216\u5e73\u5747\u8de8\u74e3\u538b\u5dee \u2265 50 mm Hg)\u60a3\u8005\u968f\u673a\u5206\u4e3a\u65e9\u671f\u624b\u672f\u6216\u4fdd\u5b88\u6cbb\u7597\u7ec4\uff08\u6839\u636e\u5f53\u524d\u6307\u5357\u7684\u63a8\u8350\uff09\u3002\u4e3b\u8981\u7814\u7a76\u91cd\u70b9\u4e3a\u590d\u5408\u6307\u6807\uff0c\u5305\u62ec\u624b\u672f\u540e30\u5929\u5185\u6b7b\u4ea1\uff08\u5e38\u79f0\u4e3a\u624b\u672f\u75c5\u6b7b\u7387\uff09\u6216\u5728\u6574\u4e2a\u968f\u8bbf\u671f\u95f4\u56e0\u5fc3\u8840\u7ba1\u539f\u56e0\u6b7b\u4ea1\u3002\u4e3b\u8981\u6b21\u8981\u7ec8\u70b9\u4e3a\u968f\u8bbf\u671f\u95f4\u4efb\u4f55\u539f\u56e0\u5bfc\u81f4\u7684\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h3>\n\n\n\n

In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P=0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years.<\/p>\n\n\n\n

\u65e9\u671f\u624b\u672f\u7ec473\u540d\u60a3\u8005\u4e2d69\u540d(95%)\u5728\u968f\u673a\u5206\u7ec4\u540e2\u4e2a\u6708\u5185\u63a5\u53d7\u4e86\u624b\u672f\u6cbb\u7597\uff0c\u65e0\u624b\u672f\u6b7b\u4ea1\u53d1\u751f\u3002\u6839\u636e\u610f\u5411\u6cbb\u7597\u5206\u6790\uff0c\u65e9\u671f\u624b\u672f\u7ec4\u4e2d1\u540d\u60a3\u8005(1%)\u53ca\u4fdd\u5b88\u6cbb\u7597\u7ec472\u540d\u60a3\u8005\u4e2d11\u540d\u60a3\u8005(15%)\u53d1\u751f\u4e3b\u8981\u7ec8\u70b9\u4e8b\u4ef6 (\u98ce\u9669\u6bd4, 0.09; 95% \u53ef\u4fe1\u533a\u95f4 [CI], 0.01 to 0.67; P=0.003)\u3002\u65e9\u671f\u624b\u672f\u7ec4\u4e0e\u4fdd\u5b88\u6cbb\u7597\u7ec4\u5206\u522b\u67095\u540d (7%) \u548c15\u540d (21%) \u60a3\u8005\u53d1\u751f\u4efb\u4f55\u539f\u56e0\u5bfc\u81f4\u7684\u6b7b\u4ea1 (\u98ce\u9669\u6bd4, 0.33; 95% CI, 0.12 to 0.90)\u3002\u5728\u4fdd\u5b88\u6cbb\u7597\u7ec4\uff0c\u731d\u6b7b\u7684\u7d2f\u8ba1\u53d1\u751f\u7387\u57284\u5e74\u65f6\u4e3a4%\uff0c8\u5e74\u65f6\u4e3a14%\u3002<\/p>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h3>\n\n\n\n

Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care.<\/p>\n\n\n\n

\u5bf9\u4e8e\u65e0\u75c7\u72b6\u7684\u6781\u4e3a\u4e25\u91cd\u7684\u4e3b\u52a8\u8109\u74e3\u72ed\u7a84\u60a3\u8005\uff0c\u4e0e\u63a5\u53d7\u4fdd\u5b88\u6cbb\u7597\u76f8\u6bd4\uff0c\u65e9\u671f\u4e3b\u52a8\u8109\u74e3\u7f6e\u6362\u624b\u672f\u80fd\u591f\u663e\u8457\u964d\u4f4e\u624b\u672f\u6b7b\u4ea1\u6216\u968f\u8bbf\u671f\u95f4\u5fc3\u8840\u7ba1\u539f\u56e0\u5bfc\u81f4\u7684\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

(Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number,\u00a0NCT01161732. opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE FREE PREVIEW Early Surgery or Conserva […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18000"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18000"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18000\/revisions"}],"predecessor-version":[{"id":18001,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18000\/revisions\/18001"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18000"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18000"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18000"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}