多血管性疾患における冠動脈バイパス手術と皮膚経由冠動脈手術の比較: 10件のランダム化試験から得られた個々の患者データの共同分析
Mark A Hlatky1, Derek B Boothroyd, Dena M Bravata
1Stanford University School of Medicine, Stanford, CA, USA.
Lancet (London, England)
|March 24, 2009
まとめ
冠動脈バイパス移植 (CABG) と皮膚経冠動脈介入 (PCI) は,ほとんどの多血管冠動脈疾患患者の長期的な死亡率に類似しています. しかし,CABGは,糖尿病患者および65歳以上の患者にとって,より高い生存率を提供することがあります.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 心血管外科手術についてです.
背景:
- 冠動脈バイパス移植 (CABG) と皮膚経冠動脈介入 (PCI) は,多血管冠動脈疾患の主要な治療法です.
- 特定の患者のサブグループにおけるCABGとPCIの間の長期的な死亡率の違いは不明である.
研究 の 目的:
- ランダム化試験のデータを共同で分析し,CABGとPCIの間の長期的な死亡率のアウトカムを比較する.
- 患者の特徴が死亡率に対する治療効果を変化させるかどうかを調査する.
主な方法:
- 7812人の患者が参加した10件のランダム化試験の個々の患者データをプールしました.
- 階層化,ランダムな効果による治療意図分析を用いた. コックス比例リスクモデル.
- すべての原因による死亡率に対する治療効果と,基礎臨床特異との相互作用を検証した.
主要な成果:
- CABGとPCI (HR 0.91,p=0.12) の間で,全体的な長期的な死亡率は類似していました.
- CABGは,糖尿病患者 (HR 0.70) と65歳以上の患者 (HR 0.82) の死亡率が著しく低下したことを実証しました.
- 死亡率は,糖尿病のない患者と65歳未満の患者の治療の間に類似しており,糖尿病と年齢 (p=0.014とp=0.002,それぞれ) の有意な相互作用がありました.
結論:
- 多くの多血管性冠動脈疾患の患者で,CABGとPCIの長期的な死亡率は比較可能です.
- 治療の決定は,他のアウトカムに対する患者の好みを考慮する必要があります.
- CABGは,糖尿病患者および高齢者 (≥65歳) の患者では,これらのグループで死亡率が低いことが観察されているため,好ましいかもしれません.
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