Coronary bypass surgery with or without surgical ventricular reconstruction.
Coronary bypass surgery with or without surgical ventricular reconstruction.
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DOI：
10.1056/nejmoa0900559
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发表时间：
2009-04-23
期刊：
影响因子：
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通讯作者：
STICH Hypothesis 2 Investigators
中科院分区：
文献类型：
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作者：
Jones RH;Velazquez EJ;Michler RE;Sopko G;Oh JK;O'Connor CM;Hill JA;Menicanti L;Sadowski Z;Desvigne-Nickens P;Rouleau JL;Lee KL;STICH Hypothesis 2 Investigators
外科心室重建术是一种特殊的手术，旨在减少冠心病引起的心力衰竭患者的左心室容量。我们进行了一项试验，以解决与单纯冠状动脉旁路移植术(CABG)相比，冠状动脉旁路移植术(CABG)中加入外科心室重建是否会降低因心脏原因而死亡或住院的比率。2002年9月至2006年1月期间，共有1000名射血分数小于或等于35%的患者、可接受冠状动脉搭桥术的冠状动脉疾病、以及可接受外科心室重建的显性左前心功能不全患者被随机分配到单独接受冠状动脉搭桥术(499例)或冠状动脉旁路移植术(CABG)合并外科心室重建(501例)。主要结果是任何原因的死亡和心脏原因的住院。中位随访时间为48个月。外科心脏重建术使收缩末期容量指数降低了19%，而单纯冠脉搭桥术仅减少了6%。在两个研究组中，心脏症状和运动耐量较基线有类似程度的改善。然而，在292例(59%)单独接受CABG的患者和289例(58%)接受CABG并外科手术的患者(风险比为0.99；95%可信区间为0.84~1.17；P=0.90)中，基本结局没有显著差异。与单纯冠状动脉旁路移植术相比，冠状动脉旁路移植术中加入外科心室重建术可减少左心室容量。然而，这种解剖学上的变化与症状或运动耐量的更大改善或心脏原因死亡率或住院率的降低无关。(ClinicalTrials.gov编号，NCT00023595。)
Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P = 0.90). Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes. (ClinicalTrials.gov number, NCT00023595.)