Olando，FL-来自ACC58届年会的报道：在最优化药物治疗基础上饮食中添加ω-3脂肪酸并不能为心梗后患者带来更多的益处。

    OMEGA实验发现，以指南为依据的优化药物治疗组和在此基础上加用ω-3脂肪酸的实验组之间在心脏病发作率、卒中、心源性猝死及全因死亡率方面均没有明显差异。这项结论同之前的研究结论相反，在以往的研究中，ω-3被认为能够增加长期生存率。但是，以往的研究背景中，心肌梗死的治疗方式远不及现在先进。

    自德国的Jochen Senges教授认为：“尽管ω-3被认为能改善急性心肌梗死后病人的预后，但是目前尚没有随机对照实验证实在严格按照指南进行治疗的基础上加用ω-3脂肪酸能否带来额外的益处。”“在我们的研究中，没有发现ω-3有作用。在已经接受了最优化药物治疗的患者中，心脏事件的发生率很低，加用ω-3并不能进一步使患者获益。”

    这项研究入选了3827名者来自德国104个的社区医院、心脏中心和大学医院的患者。这些患者在心梗后的14天被随机分配接受ω-3脂肪酸治疗组或安慰剂组接受1年治疗，所有的患者同时均接受最佳的药物治疗。

    大约94%的患者在心脏病发作时接受了冠脉造影，78%的患者接受了PCI治疗以达到病变血管的血运重建。8%的患者接受了溶栓治疗。到出院时，94%的病人服用倍他乐克，83%的病人服用ACEI，94%的病人服用他汀类药物，95%接受阿司匹林治疗，88%的患者接受氯比格雷。

    在约1年的随访中，4.1%的受试者死亡，3.9%再次发生非致命性心脏事件，1.7%患非致命性卒中，1.5%的患者发生猝死。在 ω-3脂肪酸组和安慰机组，临床结果之间并没有差异。

    Senges说：“在我们的研究中，在急性心肌梗死后心脏事件的发生率很低”“现在就认为ω-3脂肪酸无效可能是不正确的，但是我们发现在优化的药物治疗基础上它确实不能带来更多的益处。”

（谭凯 吕树铮  首都医科大学附属北京安贞医院）

英文原文：
OPTIMAL HEART ATTACK CARE WIPES OUT OMEGA-3 BENEFITS
Omega-3 Fatty Acids Offer No Extra edge with Today’s Advanced Therapies

Orlando， FL – For patients who have suffered a heart attack dietary supplementation with omega-3 fatty acids added to optimal medical therapy offers no additional benefits， according to research presented today at the American College of Cardiology’s 58th annual scientific session. ACC.09 is the premier cardiovascular medical meeting， connecting cardiologists and cardiovascular specialists to the latest and most innovative findings in cardiovascular science.
The OMEGA trial found no significant differences in the rates of heart attack， stroke， sudden cardiac death or death from any cause among patients assigned to guidelines-based optimal medical care alone or optimal medical care plus omega-3 fatty acids. The findings contradict those of previous studies， which suggested that supplementation with omega-3 fatty acids improves long-term survival. However， those studies were conducted when treatment for heart attack， or myocardial infarction， was less advanced than it is today.

“Although omega-3 fatty acids are considered effective for improving prognosis after acute myocardial infarction， no randomized， double-blind trial has tested their effect on top of current， strictly guideline-based treatment，” said Jochen Senges， M.D.， a professor of cardiology at the Heart Center Ludwigshafen， University of Heidelberg， Germany. “In our study， we saw no beneficial effect. In patients who are already taking optimal medical therapy， cardiac event rates become very low and omega-3 do not further improve them.”

The study involved 3，827 patients from 104 German community hospitals， heart centers and university hospitals. Three to 14 days after having a heart attack， patients were randomly assigned to one year of treatment with highly purified omega-3 fatty acids or placebo， in addition to the best possible medical care.

Almost 94 percent of patients had coronary angiography at the time of the heart attack， and nearly 78 percent underwent percutaneous coronary intervention to restore blood flow through the blocked coronary artery. In about 8 percent of patients， “clot-busting” medications were used as the primary treatment. Upon discharge from the hospital， almost 94 percent of patients were prescribed beta-blockers， 83 percent ACE inhibitors， 94 percent statins， 95 percent aspirin and 88 percent clopidogrel， an anti-clotting medication.

During a follow-up that averaged just over one year， 4.1 percent of patients died， 3.9 percent had another non-fatal heart attack， 1.7 percent had a non-fatal stroke and 1.5 percent experienced sudden cardiac death. There were no significant differences in clinical outcomes between patients assigned to omega-3 fatty acids and those assigned to placebo.
“In our study， there was a very low rate of cardiac events after acute myocardial infarction，” Senges said. “It would be incorrect to say that omega-3 fatty acids are not effective， but we could not find any additional benefits after optimizing medical therapy.”