在手术前进行素扫描,选择性冠状动脉再血管化,以及在进行大血管手术后的长期存活
Giora Landesberg1, Morris Mosseri, Yehuda G Wolf
1Department of Anesthesiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel. gio@cc.huji.ac.il
Circulation
|July 2, 2003
概括
冠状动脉再血管 (CR) 在重大血管手术前在手术前的素扫描 (PTS) 上检测到中度至重度缺血的患者中显著改善了长期存活率. 这种干预对于改善高风险心脏病患者的治疗结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 核心脏病学 核心脏病学
背景情况:
- 通过素扫描检测到的缺血是冠状动脉疾病 (CAD) 患者死亡率的重要预测因素.
- 冠状动脉再血管化 (CR) 对患有显著缺血症的患者在接受大血管手术的手术前光扫描 (PTS) 上的长期生存的影响尚不清楚.
研究的目的:
- 为了确定在PTS显著缺血的患者中CR是否改善了主要血管手术后的长期存活率.
- 分析手术前心脏干预和该患者队列的长期死亡率之间的关联.
主要方法:
- 对502名接受578次主要血管手术的患者的术后数据和长期存活率的回顾性分析.
- 利用考克斯回归和倾向得分分析来评估生存结果.
- 根据PTS发现和随后的CR (CABG或PTCA) 来分类患者.
主要成果:
- 在PTS中中度至重度缺血独立预测死亡率.
- 手术前的CR与改善的长期存活率相关 (OR0.52,P=0.018).
- 接受CR (第四组) 的患者比不接受CR (第三组) 的缺血患者的生存率更好.
结论:
- 选择性CR推给患有中度至重度PTS缺血的患者进行大血管手术.
- 在这种高风险人群中,CR显著提高了长期生存率.
- 这种策略优化了接受主要血管手术的CAD患者的结果.
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