优化医疗护理与冠状动脉血流容量引导的心肌血运重建术对比常规护理治疗慢性冠状动脉疾病：CENTURY试验
Optimal medical care and coronary flow capacity-guided myocardial revascularization vs usual care for chronic coronary artery disease: the CENTURY trial.
作者信息
Gould K Lance, Johnson Nils P, Roby Amanda E, Kirkeeide Richard, Haynie Mary, Nguyen Tung, Bui Linh, Patel Monica B, Kitkungvan Danai, Mendoza Patricia, Lai Dejian, Li Ruosha, Sdringola Stefano, McPherson David, Narula Jagat
机构信息
Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas McGovern Medical School, 6431 Fannin St., Room MSB 4.256, and Memorial Hermann Hospital, Houston, TX 77030, USA.
Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, TX, USA.
出版信息
Eur Heart J. 2025 Sep 2;46(33):3273-3286. doi: 10.1093/eurheartj/ehaf356.
BACKGROUND AND AIMS
The randomized CENTURY trial tested the hypothesis that a comprehensive strategy integrating intense lifestyle modification and aggressive medical management to goals with revascularization reserved for severely reduced coronary flow capacity (CFC) by positron emission tomography (PET) would reduce risk factors, subsequent revascularization, death and myocardial infarction (MI) compared with standard of care in chronic stable coronary artery disease (CAD).
METHODS
Participants were randomly assigned to standard or comprehensive care groups. Rest-stress PET quantified CFC for physiological CAD severity at baseline, 2, 5, and up to 11 years. The comprehensive care group reviewed PET results with frequent clinic visits and open 24/7 phone/email support. Standard care lacked supportive contact with blinded PET results that were unblinded only for severely reduced CFC with high mortality risk for potential revascularization.
RESULTS
Between 2009-2017, 515 patients were assigned to comprehensive care and 513 to standard care and followed for 5 or more years. Comprehensive vs standard care decreased risk factors and summed 5-year risk score (Δ-1.1 vs + 0.33; 95% confidence interval -1.84 to -0.97; P < .0001), decreased cumulative 11-year all-cause death (4.7% vs 8.2%; P = .023), death or MI (7.0% vs 11.1%; P = .024) late revascularization (9.5% vs 14.8%; P = .021) and major adverse cardiac events (20.5% vs 29.9%; P = .0006). Only 56 of 1028 (5.4%) CENTURY patients with chronic CAD had revascularization within 90 days predominantly guided by CFC severity.
CONCLUSIONS
The randomized CENTURY trial demonstrates that comprehensive integrated lifestyle modification and medical management towards goals with revascularization reserved for severely reduced CFC, significantly reduced risk factor scores, death, death or MI, and revascularization.
CLINICALTRIALS.GOV: NCT00756379.
背景与目的
随机对照的CENTURY试验检验了以下假设：与慢性稳定型冠状动脉疾病（CAD）的标准治疗相比，一种综合策略，即整合强化生活方式改变和积极的药物治疗以实现目标，并将血管重建术保留用于通过正电子发射断层扫描（PET）显示冠状动脉血流容量（CFC）严重降低的情况，将降低风险因素、后续血管重建术、死亡和心肌梗死（MI）的发生率。
方法
参与者被随机分配到标准治疗组或综合治疗组。静息-负荷PET在基线、2年、5年以及长达11年时对生理性CAD严重程度进行CFC定量。综合治疗组通过频繁门诊就诊以及24/7开放的电话/电子邮件支持来查看PET结果。标准治疗缺乏对PET结果的支持性沟通，PET结果仅在CFC严重降低且具有潜在血管重建术高死亡风险时才解除盲法。
结果
在2009年至2017年期间，515例患者被分配到综合治疗组，513例患者被分配到标准治疗组，并随访5年或更长时间。与标准治疗相比，综合治疗降低了风险因素和5年风险总分（差值为-1.1 vs +0.33；95%置信区间为-1.84至-0.97；P <.0001），降低了11年累积全因死亡率（4.7% vs 8.2%；P =.023）、死亡或MI发生率（7.0% vs 11.1%；P =.024）、晚期血管重建术发生率（9.5% vs 14.8%；P =.021）以及主要不良心脏事件发生率（20.5% vs 29.9%；P =.0006）。在1028例CENTURY慢性CAD患者中，只有56例（5.4%）在90天内进行了血管重建术，主要由CFC严重程度指导。
结论
随机对照的CENTURY试验表明，综合强化生活方式改变和药物治疗以实现目标，并将血管重建术保留用于CFC严重降低的情况，可显著降低风险因素评分、死亡、死亡或MI以及血管重建术的发生率。
临床试验注册
NCT00756379。
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