{"id":18129,"date":"2019-12-30T05:08:03","date_gmt":"2019-12-29T21:08:03","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18129"},"modified":"2020-01-11T06:18:01","modified_gmt":"2020-01-10T22:18:01","slug":"18129","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18129","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u7efc\u5408\u8840\u7ba1\u6269\u5f20\u6cbb\u7597\u7b56\u7565\u4e0e\u5e38\u89c4\u6cbb\u7597\u5bf9\u6025\u6027\u5fc3\u8870\u60a3\u8005\u75c5\u6b7b\u7387\u53ca\u5fc3\u8870\u518d\u4f4f\u9662\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation December 17, 2019<\/p>\n\n\n\n

Effect of a Strategy of Comprehensive Vasodilation vs Usual Care on Mortality and Heart Failure Rehospitalization Among Patients With Acute Heart Failure: The GALACTIC Randomized Clinical Trial<\/h1>\n\n\n\n

Nikola Kozhuharov, Assen Goudev, Dayana Flores, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;322(23):2292-2302. doi:10.1001\/jama.2019.18598<\/h3>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF).<\/p>\n\n\n\n

\u77ed\u671f\u8f93\u6ce8\u4e00\u79cd\u8840\u7ba1\u6269\u5f20\u5242\uff08\u901a\u5e38\u4e3a\u56fa\u5b9a\u5242\u91cf\uff09\u4e0d\u80fd\u6539\u5584\u6025\u6027\u5fc3\u8870(AHF)\u60a3\u8005\u7684\u9884\u540e\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684 <\/h3>\n\n\n\n

To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF.<\/p>\n\n\n\n

\u8bc4\u4ef7\u901a\u8fc7\u4e2a\u4f53\u5316\u4e0a\u8c03\u8840\u7ba1\u6269\u5f20\u5242\u7684\u5242\u91cf\u8fdb\u884c\u65e9\u671f\u5f3a\u5316\u4e14\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u7b56\u7565\u5bf9AHF\u60a3\u8005\u7684\u7597\u6548\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h3>\n\n\n\n

Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019.<\/p>\n\n\n\n

\u8fd9\u9879\u968f\u673a\u3001\u5f00\u653e\u6807\u7b7e\u3001\u7ec8\u70b9\u8bbe\u76f2\u4e34\u5e8a\u8bd5\u9a8c\u5728\u745e\u58eb\u3001\u4fdd\u52a0\u5229\u4e9a\u3001\u5fb7\u56fd\u3001\u5df4\u897f\u548c\u897f\u73ed\u7259\u768410\u4e2a\u4e09\u7ea7\u548c\u4e8c\u7ea7\u533b\u9662\u7684\u666e\u901a\u75c5\u623f\u8fdb\u884c\uff0c\u5165\u9009788\u540d\u4f34\u968f\u547c\u5438\u56f0\u96be\u3001\u8840\u6d46\u5229\u94a0\u80bd\u6c34\u5e73\u5347\u9ad8\u3001\u6536\u7f29\u538b\u81f3\u5c11100 mmHg\u4e14\u9700\u8981\u63a5\u53d7\u6cbb\u7597\u7684AHF\u4f4f\u9662\u60a3\u8005\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h3>\n\n\n\n

Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n\u2009=\u2009386) or usual care (n\u2009=\u2009402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan.<\/p>\n\n\n\n

\u60a3\u8005\u6309\u71671:1\u7684\u6bd4\u4f8b\u968f\u673a\u5206\u81f3\u65e9\u671f\u5f3a\u5316\u53ca\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u7b56\u7565 (n\u2009=\u2009386) \u6216\u5e38\u89c4\u6cbb\u7597 (n\u2009=\u2009402)\u3002\u65e9\u671f\u5f3a\u5316\u53ca\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u6307\u7ef4\u6301\u6700\u5927\u5316\u4e14\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u7684\u7efc\u5408\u63aa\u65bd\uff0c\u8054\u5408\u4f7f\u7528\u4e2a\u4f53\u5316\u820c\u4e0b\u548c\u7ecf\u76ae\u785d\u9178\u916f\uff0c\u53e3\u670d\u5c0f\u5242\u91cf\u80bc\u82ef\u54d2\u55ea48\u5c0f\u65f6\uff0c\u5feb\u901f\u4e0a\u8c03ACEI\u3001ACB\u6216\u6c99\u5e93\u5df4\u66f2\u7f2c\u6c99\u5766\u5242\u91cf\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u7ec8\u70b9<\/h3>\n\n\n\n

The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u590d\u5408\u6307\u6807\uff0c\u5305\u62ec180\u5929\u5185\u5168\u56e0\u75c5\u6b7b\u7387\u6216\u56e0AHF\u518d\u5165\u9662\u7387\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, \u22123.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P<\/em>\u2009=\u2009.59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%).<\/p>\n\n\n\n

\u5171\u6709788\u540d\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c781\u540d (99.1%; \u4e2d\u4f4d\u5e74\u9f84, 78 \u5c81; 36.9% \u5973\u6027) \u5b8c\u6210\u8bd5\u9a8c\uff0c\u7eb3\u5165\u4e3b\u8981\u7ec8\u70b9\u5206\u6790\u3002779\u540d (99.7%) \u60a3\u8005\u5b8c\u6210180\u5929\u968f\u8bbf\u3002\u5e72\u9884\u7ec4117\u540d\u60a3\u8005(30.6%) (\u5305\u62ec 55 \u4f8b\u6b7b\u4ea1 [14.4%]) \u53ca\u5e38\u89c4\u6cbb\u7597\u7ec4 111 \u540d (27.8%) \u60a3\u8005 (\u5305\u62ec 61 \u4f8b\u6b7b\u4ea1 [15.3%]) \u53d1\u751f\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e8b\u4ef6\uff0c\u5373180\u5929\u5168\u56e0\u75c5\u6b7b\u7387\u6216\u56e0AHF\u518d\u5165\u9662\u7387 (\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u7edd\u5bf9\u5dee\u5f02, 2.8% [95% CI, \u22123.7% to 9.3%]; \u6821\u6b63\u540e\u98ce\u9669\u6bd4, 1.07 [95% CI, 0.83-1.39]; P<\/em>\u2009=\u2009.59)\u3002\u65e9\u671f\u5f3a\u5316\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u4e0e\u5e38\u89c4\u6cbb\u7597\u6700\u5e38\u89c1\u7684\u6709\u4e34\u5e8a\u610f\u4e49\u7684\u4e0d\u826f\u4e8b\u4ef6\u5305\u62ec\u4f4e\u94be\u8840\u75c7 (23% vs 25%)\uff0c\u80be\u529f\u80fd\u6076\u5316 (21% vs 20%)\uff0c\u5934\u75bc (26% vs 10%)\uff0c\u5934\u6655 (15% vs 10%) \u548c\u4f4e\u8840\u538b (8% vs 2%)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.<\/p>\n\n\n\n

\u5bf9\u4e8eAHF\u60a3\u8005\uff0c\u4e0e\u5e38\u89c4\u6cbb\u7597\u76f8\u6bd4\uff0c\u65e9\u671f\u5f3a\u5316\u6301\u7eed\u8840\u7ba1\u6269\u5f20\u7b56\u7565\u4e0d\u80fd\u663e\u8457\u6539\u5584\u590d\u5408\u9884\u540e\u6307\u6807\uff08\u5305\u62ec180\u5929\u5168\u56e0\u75c5\u6b7b\u7387\u53caAHF\u518d\u6b21\u4f4f\u9662\uff09\u3002<\/p>\n\n\n\n

Trial Registration<\/strong> \u8bd5\u9a8c\u6ce8\u518c<\/h3>\n\n\n\n

ClinicalTrials.gov Identifier: NCT00512759<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation December 17, 2019 […]<\/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\/18129"}],"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=18129"}],"version-history":[{"count":5,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18129\/revisions"}],"predecessor-version":[{"id":18137,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18129\/revisions\/18137"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18129"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18129"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}