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Đánh giá ý nghĩa tiên lượng của các nghiên cứu tưới máu cơ tim: Xác định bệnh nhân có nguy cơ so với bệnh nhân có thể hưởng lợi từ can thiệp?
Tóm tắt
Hình ảnh tưới máu cơ tim dưới stress (MPI) đã có vai trò nổi bật trong việc cải thiện phân tầng nguy cơ. Các phân tích gần đây, so với dữ liệu cũ, cho thấy rằng tỉ lệ thành công của MPI dưới stress đã giảm. Một phần, xu hướng này liên quan đến việc kiểm tra những bệnh nhân có các yếu tố nguy cơ không đồng nhất nhưng đã được cải thiện. Trong bối cảnh này, chụp cắt lớp phát xạ positron với dự trữ dòng máu cơ tim nâng cao phân tầng nguy cơ vì nó phản ánh kết quả cuối cùng của xơ vữa động mạch. Các nghiên cứu gần đây cũng đã nhấn mạnh tác động lâm sàng của việc phân tầng nguy cơ gia tăng thông qua việc đánh giá cải thiện phân loại ròng (NRI). Các nghiên cứu hồi cứu trước đây ủng hộ ngưỡng thiếu máu để lựa chọn bệnh nhân có thể hưởng lợi từ tái tưới máu, nhưng phát hiện này chưa được xác nhận trong các thử nghiệm ngẫu nhiên. Tuy nhiên, chưa có thử nghiệm ngẫu nhiên lớn nào kiểm tra trực tiếp một chiến lược tái tưới máu cho các bệnh nhân có ít nhất một lượng thiếu máu ở mức vừa phải. Đáng tiếc, ngay cả khi đối mặt với kết quả MPI bất thường một cách rõ rệt, hành động tiếp theo thường bị thiếu vắng.
Từ khóa
#tưới máu cơ tim #phân tầng nguy cơ #thiếu máu #chụp cắt lớp phát xạ positron #cải thiện phân loại ròngTài liệu tham khảo
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