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Rationale and design of the randomised Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation trial (TEAM-ASV I).

自适应伺服通气试验 (TEAM-ASV I) 随机治疗心肌梗死后早期睡眠呼吸暂停的原理和设计。

  • 影响因子:2.12
  • DOI:10.1186/s13063-020-4091-z
  • 作者列表:"Fox H","Hetzenecker A","Stadler S","Oldenburg O","Hamer OW","Zeman F","Bruch L","Seidel M","Buchner S","Arzt M","TEAM-ASV I Investigators.
  • 发表时间:2020-01-31
Abstract

AIMS:In acute myocardial infarction (AMI), impaired myocardial salvage and large infarct size result in residual heart failure, which is one of the most important predictors of morbidity and mortality after AMI. Sleep-disordered breathing (SDB) is associated with reduced myocardial salvage index (MSI) within the first 3 months after AMI. Adaptive servo-ventilation (ASV) can effectively treat both types of SDB (central and obstructive sleep apnoea). The Treatment of sleep apnoea Early After Myocardial infarction with Adaptive Servo-Ventilation trial (TEAM-ASV I) will investigate the effects of ASV therapy, added to percutaneous coronary intervention (PCI) and optimal medical management of AMI, on myocardial salvage after AMI. METHODS/DESIGN:TEAM ASV-I is a multicentre, randomised, parallel-group, open-label trial with blinded assessment of PCI outcomes. Patients with first AMI and successful PCI within 24 h after symptom onset and SDB (apnoea-hypopnoea index ≥ 15/h) will be randomised (1:1 ratio) to PCI and optimal medical therapy alone (control) or plus ASV (with stratification of randomisation by infarct location; left anterior descending (LAD) or no LAD lesion). The primary outcome is the MSI, assessed by cardiac magnetic resonance imaging. Key secondary outcomes are change of infarct size, left ventricular ejection fraction and B-type natriuretic peptide levels and disease-specific symptom burden at 12 weeks. CONCLUSION:TEAM ASV-I will help to determine whether treatment of SDB with ASV in the acute phase after myocardial infarction contributes to more myocardial salvage and healing. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02093377. Registered on March 21, 2014.

摘要

目的: 在急性心肌梗死 (AMI) 中,心肌挽救受损和大梗死面积导致残余心力衰竭,是 AMI 后发病率和死亡率的最重要预测因素之一。睡眠呼吸障碍 (SDB) 与 AMI 后前 3 个月内心肌挽救指数 (MSI) 降低相关。自适应伺服通气 (ASV) 可有效治疗两种 SDB (中枢性和阻塞性睡眠呼吸暂停)。自适应伺服通气试验 (TEAM-ASV I) 治疗心肌梗死后早期睡眠呼吸暂停将研究 ASV 治疗的效果,加入经皮冠状动脉介入治疗 (PCI) 和 AMI 的最佳医疗管理,对 AMI 后的心肌挽救。 方法/设计: ASV-I 团队是一项多中心、随机、平行组、开放标签试验,盲法评估 PCI 结局。首次 AMI 并在症状发作后 24 h 内成功 PCI 且 SDB (呼吸暂停低通气指数 ≥ 15/h) 的患者将被随机分组 (1:1 比) PCI 和最佳药物治疗单独 (对照) 或加 ASV (按梗死部位随机分层; 左前降支 (LAD) 或无 LAD 病变)。主要结局是通过心脏磁共振成像评估的 MSI。关键的次要结局是 12 周时梗死面积、左心室射血分数和 b型钠尿肽水平的变化以及疾病特异性症状负担。 结论: ASV-I 团队将有助于确定心肌梗死后急性期应用 ASV 治疗 SDB 是否有助于更多的心肌挽救和愈合。 试用注册: ClinicalTrials.gov,nct02093377。2014年3月21日注册。

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