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高齢者におけるポンプ外またはポンプ内冠動脈バイパス移植後の5年間の結果
Anno Diegeler1, Jochen Börgermann2, Utz Kappert3
1Herz- und Gefäß-Klinik, Bad Neustadt, Germany (A.D., M.Z., W.R.).
Circulation
|February 9, 2019
まとめ
ポンプ外対ポンプ内冠動脈バイパス移植 (CABG) を受けた高齢者の5年生存率は類似した. 手術方法に関係なく,不完全な再血管化は生存率を大幅に低下させた.
科学分野:
- 心臓病科
- 心臓外科
- 高齢者医療
背景:
- ドイツのOff-Pump冠動脈バイパス移植 (GOPCABE) 試験では,30日と1年後に有意な差異は示されなかった.
- この研究では,GOPCABE試験の5年間の追跡データを報告しています.
研究 の 目的:
- 75歳以上の患者で,オフ・ポンプ対オン・ポンプ冠動脈バイパス移植 (CABG) の5年経過を評価する.
- 長期生存と結果に対する完全な対不完全な再血管化の影響を評価する.
主な方法:
- ポンプ外またはポンプ内CABGに割り当てられた75歳以上の患者2539人を対象としたランダム化試験.
- 5年間の全原因死亡率 二次的アウトカム:死亡,心筋梗塞,再循環,および再循環の完全性の影響の複合.
主要な成果:
- ポンプ外 (31%) とポンプ内 (30%) のCABG群の5年間の全因死亡率は有意な差異はなかった (HR1. 03; P=0. 71).
- 死亡率,心筋梗塞,再循環率 (34%対33%;HR1. 03;P=0. 704) の複合結果は同様でした.
- 不完全な再血管化は,オフポンプ群でより頻繁であり (34%対29%;P<0. 001) 5年生存率が低かった (HR 1. 19;P=0. 04).
結論:
- 高齢者 (75歳以上) の患者では,5年生存率と主要複合アウトカムが,オフポンプとオンポンプのCABGで類似している.
- CABGの手術技術とは無関係に,不完全な再血管化は5年生存率の減少と関連しています.
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