MOMENTUM 3 研究の長期コホートにおける脳卒中の包括的な分析
Paolo C Colombo1, Mandeep R Mehra2, Daniel J Goldstein3
1Columbia University Medical Center, New York, NY (P.C.C.).
Circulation
|December 28, 2018
まとめ
ハートメイト3 (HM3) ポンプは,ハートメイトII (HMII) と比較して,進行性心不全患者の長期間の脳卒中を有意に減少させます. 脳卒中の発生は 種類や重度に関係なく 2年生存率の低下を予測します
科学分野:
- 心臓病科
- 神経学
- 生物医学工学
背景:
- MOMENTUM 3試験では,ハートメイト3 (HM3) の左心房補助器具 (LVAD) がハートメイトII (HMII) に比べて少数の脳卒中を示した.
- この分析は,HM3またはHMIIの治療を受けた患者の2年間の脳卒中の詳細な検査を提供します.
研究 の 目的:
- HM3対HMIIデバイスでサポートされた患者の脳卒中の長期的発生,臨床的相関,パターン,アウトカムを包括的に分析する.
- 脳卒中の予測要因を特定し,脳卒中の長期的な生存への影響を評価する.
主な方法:
- HM3 (遠心流) とHMII (軸流) ポンプを比較したランダム化制御試験.
- 多変量分析を用いて,初期と移植後の脳卒中の相関値を評価した.
- 脳卒中の縦断的なパターン (出血と非出血,障害と非障害) と2年経過との関連が決定された.
主要な成果:
- 361人の患者で,65人の脳卒中が発生しました. 長期性脳卒中 (181~730日) の発生率は,HM3 (0. 04件の/患者年) とHMII (0. 13件の/患者年) で3. 3倍低かった.
- HM3ポンプ治療は,脳卒中の減少を予測する唯一の独立要因であり,血圧と抗血栓療法との直接的な関連は示されなかった.
- 脳卒中患者は,脳卒中のない患者と比較して,2年生存率 (43~57%) を著しく低下させた.
結論:
- HM3ポンプは,HMII装置と比較して,特に長期にわたって,脳卒中率の有意な減少を示しています.
- 脳卒中の発生は,その種類や重度に関係なく,LVAD患者の2年間の臨床結果の有意な予測因子です.
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