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心不全の治療として腎動脈狭窄の再血管化:観察コホート研究
Darren Green1, James P Ritchie1, Constantina Chrysochou2
1Institute of Population Health, University of Manchester, Manchester, UK.
Lancet (London, England)
|August 28, 2015
まとめ
心不全患者の腎動脈再血管化は,死亡率と入院率を大幅に低下させた. 心不全の診療では,この治療法のさらなる検討が推奨されます.
科学分野:
- 心臓病科
- 腎臓科
- 血管医学
背景:
- 4年間の死亡率は50%以上です.
- 腎動脈狭窄は,心不全の患者の54%に影響します.
- 心不全に対する再血管化の治療的効果は未確認である.
研究 の 目的:
- 腎動脈再血管化の臨床結果と,心不全および腎動脈狭窄症の患者の医療治療を比較する.
- 心不全の治療法として 血管再生を検証する
主な方法:
- イギリスの腎臓病学センターでの将来的,縦断的な観察研究.
- 動脈硬化性腎動脈狭窄症 (> 50%) の患者を募った.
- 終点には全因死亡率と心不全による入院が含まれ,生存分析ではコックス比例リスクモデルを使用した.
主要な成果:
- 平均年齢70歳,平均EGFR33mL/ min/ 1. 73m2であった.
- 心不全患者の31%で再血管化は行われました.
- 心不全患者の再血管化は,全因死亡率の有意な低下 (HR 0. 6, p=0. 01) と心不全による入院率の減少 (HR 0. 2, p=0. 06) と関連していた.
結論:
- 心不全における腎動脈狭窄の再血管化は,死亡率と入院率の有意な減少と関連しています.
- 観察データは 潜在的な利益を示唆し,ランダム化試験を正当化しています.
- 心不全の診療所で腎動脈狭窄の検査を強化することが推奨されます.
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