评估左主冠状动脉疾病的创新治疗的基准
Joseph F Sabik1, Eugene H Blackstone, Michael Firstenberg
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave/Desk F24, Cleveland, OH 44195, USA. sabikj@ccf.org
Circulation
|September 14, 2007
概括
这项研究建立了冠状动脉旁路移植在左主干狭窄患者的20年基准. 风险因素调整对于比较治疗方法和个性化患者策略至关重要.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 临床结果研究研究
背景情况:
- 左主干狭窄 (≥50%) 传统上用冠状动脉旁路移植 (CABG) 进行治疗.
- 立体支架的进步迅速考虑穿皮冠状动脉干预 (PCI).
- 需要一个基准来比较PCI结果与CABG.
研究的目的:
- 评估CABG后左主干狭窄症的20年生存期和无需重新干预的情况.
- 确定影响这些患者结果的风险因素.
主要方法:
- 对3803名患有左主干狭窄症 (≥50%) 的患者的回顾性分析,从26927名接受初级CABG (1971-1998) 的队列中.
- 多变量,与时间相关的分析,以模型生存和重新干预 (PCI或重新操作).
- 随访5年间隔到20年.
主要成果:
- 20年生存率为28%;无需重新干预的情况为61%.
- 降低生存时间的危险因素: LV 功能恶化,糖尿病,高血压,PAD,吸烟,甘油三水平升高.
- 增加再干预的危险因素:年龄较小,甘油三升高,不完全的再血管化.
- 内胸动脉移植改善了生存率和减少了重新干预.
结论:
- 提供了对左主干病的手术治疗的20年结果基准.
- 强调简单的治疗比较没有风险调整是不充分的.
- 建议进行风险因素调整,以便将CABG与新干预措施进行比较,并为患者特定的治疗选择.
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