手术复血管化与患有缺血性额外外的患者的最大生存率有关:20年的经验:
Anthony W Castleberry1, Judson B Williams1, Mani A Daneshmand1
1From the Department of Surgery; The Division of Cardiovascular and Thoracic Surgery (A.W.C., J.B.W., M.A.D., C.A.M., P.K.S.); Duke Clinical Research Institute (J.B.W., E.H., L.K.S., R.D.L., J.H.A., E.J.V.); Department of Medicine, Division of Cardiology (Z.S., R.D.L., J.H.A., E.J.V.); and Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine (J.P.M.), Duke Medicine, Durham, NC.
Circulation
|April 19, 2014
概括
对于患有缺血额头吐和冠状动脉疾病的患者,冠状动脉旁路移植 (CABG) 单独提供了最低的死亡风险. 与其他治疗相比,有或没有门手术的CABG改善了存活率.
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:
- 对缺血性 mitrale 吐 (IMR) 的最佳治疗方法进行了辩论.
- IMR通常与显著的冠状动脉疾病 (CAD) 共同存在.
研究的目的:
- 评估IMR治疗策略与患者存活率之间的关系.
- 为了比较医疗管理,PCI,CABG和CABG与门干预的结合结果.
主要方法:
- 对4989名患有显著CAD和中度/重度IMR的患者 (1990-2009) 的回顾性审查.
- 治疗组:医疗治疗,皮肤冠状动脉干预 (PCI),冠状动脉旁路移植 (CABG) 和CABG加上关手术.
- 使用Kaplan-Meier和多变量Cox模型进行生存分析,并进行倾向得分调整.
主要成果:
- 单独使用CABG (33%的患者) 的死亡率明显低于单独使用医疗治疗 (36%).
- 与药物治疗相比,PCI (26%) 也显示死亡率降低.
- CABG加上关手术 (5%) 的死亡率低于药物治疗和PCI,但与单独的CABG没有显著差异.
- 根据IMR严重程度,结果没有显著差异.
结论:
- 冠状动脉旁路移植 (CABG) 单独与显著的CAD和IMR患者的最低死亡风险有关.
- CABG,与或没有中枢干预,提供优越的存活率相比,穿皮冠状动脉干预或单独的医疗管理.
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