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左心室機能不全患者の冠動脈バイパス手術のリスク分層:冠動脈バイパス移植パッチ試験データベースの分析
M Argenziano1, H M Spotnitz, W Whang
1Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. ma66@columbia.edu
Circulation
|November 24, 1999
まとめ
症状のある心不全と再手術は,心室機能不全で冠動脈バイパス移植 (CABG) を受けている患者の手術後の死亡率を高めます. 心不全の症状のない患者は,低死亡リスクでCABGを受けることができます.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
背景:
- 術前患者の特徴は,冠動脈バイパス移植 (CABG) の後の結果に大きく影響します.
- CABGパッチ・トライアルでは,高リスクのCABG患者に予防的に植入可能な心変容器-除細動器の挿入を調査した.
- この研究では,CABG パッチ・トライアルデータベースを利用して,心不全 (CHF) と胸痛が心室機能不全患者の罹患率と死亡率に及ぼす影響を調べました.
研究 の 目的:
- 冠動脈バイパス移植 (CABG) を受け,心室機能不全を有する患者の罹病率および死亡率に,症状のある結血性心不全 (CHF) と心痛の影響を調査する.
- この患者集団における手術後の死亡率の増加と長期滞在期間 (LOS) の予測要因を特定する.
主な方法:
- 射出分数 ≤35%と異常な信号平均EKGを有する900人のランダムに選ばれた患者のデータを分析した.
- 死亡率とLOS分析のための単変数および段階的な複数のロジスティック回帰を使用しました.
- NYHA分類を用いたCHFの度別重度,CCS分類を用いたアンギナ.
主要な成果:
- 術後の死亡率は,症状のある心不全患者 (7.7%) と,症状のない患者 (3.5%) と比較して高かった.
- 症状性心不全 (NYHAクラスI-IV) と再手術は,死亡率増加の有意な予測要因でした.
- 脳卒中の病歴は,手術前脳卒中の発生率が高いことと,LOSの増加と関連していました.
結論:
- 症状性心不全と再手術は,心室機能不全のCABG患者における手術後の死亡率の増加の主要な予測因子である.
- 心不全の症状のない患者は,エジェクション分数が減少したにもかかわらず,比較的低い死亡率を有することがあります.
- 高齢,脳卒中歴,心不全の存在/重症度は, LOSを大幅に延長します.
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