经冠状动脉旁路移植的缺血性心力衰竭患者的突然心脏死亡:STICH随机临床试验的结果 (缺血性心力衰竭的手术治疗)
Meena P Rao1, Sana M Al-Khatib1, Sean D Pokorney1
1From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.).
在冠状动脉旁路移植 (CABG) 手术后,心力衰竭患者心脏突然死亡 (SCD) 的风险较高. 早期风险分层至关重要,特别是在30至90天内,使用末体积指数和B型尿素.
科学领域:
- 心脏病学
- 心脏外科
- 心脏衰竭的治疗方法
背景情况:
- 在心力衰竭患者的冠状动脉旁路移植 (CABG) 后,突然心脏死亡 (SCD) 风险缺乏当代试验数据.
- 本研究研究了CABG后的SCD发病率,时间和预测因素.
研究的目的:
- 确定因缺血性心力衰竭而接受CABG的患者中SCD的发生率,时间和临床预测因素.
- 在术后期为早期风险分层策略提供信息.
主要方法:
- 从STICH试验中分析的患者 (有或没有心室重建的CABG).
- 排除之前使用植入式心脏除器的患者或仅随机选择接受医疗治疗的患者.
- 一个盲目的委员会对SCD的裁决;用于分析的Cox和Fine-Gray模型.
主要成果:
- 在46个月内,1411名CABG患者中有113人出现SCD (5年发病率为8. 5%).
- 在CABG后31至90天间,SCD风险最高.
- 末体积指数和B型尿素是SCD的强烈预测因素.
结论:
- 在CABG后的前三个月内,每月发生SCD的风险最高.
- 对于低射出分数的患者,建议进行早期的术后风险分层.
- 在手术前增加的末体积指数和B型尿素可以识别高危人群.
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