在用磁升起左心室辅助装置管理患者的5年死亡率的预测因素
Aditi Nayak1, Shelley A Hall2, Nir Uriel3
1Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|August 23, 2023
概括
对于手术后出院的HeartMate 3左心室辅助器件 (LVAD) 接受者,植入前因素和医院内事件显著影响5年生存率. 识别风险预测因素可以改善晚期心力衰竭患者的长期结果.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 接受HeartMate 3 (HM3) 左心室辅助装置 (LVAD) 的高级心力衰竭患者在出院后的5年死亡风险概况未知.
- 植入前因素和医院住院指数事件是这些患者长期生存的关键决定因素.
研究的目的:
- 确定在初次住院后出院的HM3 LVAD接受者中5年死亡率的预测因素.
- 分析基线特征和住院事件对长期生存的影响.
主要方法:
- 从MOMENTUM 3关键试验中,在HM3 LVAD植入后出院的485名患者的分析.
- 评估植入前,植入手术和医院住院指数特征作为5年死亡率的预测因素.
- 多变量分析以确定独立的风险因素.
主要成果:
- 累积5年死亡率在队列中为38%.
- 植入前的因素 (升高的BUN,心脏手术前) 和植入后的事件 (血液兼容性问题,心室失常,出院时低EGFR) 预测了5年死亡率.
- 没有风险预测因素的患者5年死亡率为22.6%,而具有预测因素的患者的死亡率为45.7%.
结论:
- 已出院的HM3 LVAD患者的长期存活率受到基线因素和医院住院事件指数的影响.
- 没有确定的风险预测因子的患者显示5年死亡率低,与心脏移植结果相比.
- 即使考虑了风险因素,大多数患者的5年死亡率仍低于50%.
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