Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.
Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy.
复制标题
缺血性心肌病患者的冠状动脉搭桥手术。
DOI：
10.1056/nejmoa1602001
复制
发表时间：
2016-04-21
期刊：
影响因子：
--
通讯作者：
STICHES Investigators
中科院分区：
文献类型：
--
作者：
Velazquez EJ;Lee KL;Jones RH;Al-Khalidi HR;Hill JA;Panza JA;Michler RE;Bonow RO;Doenst T;Petrie MC;Oh JK;She L;Moore VL;Desvigne-Nickens P;Sopko G;Rouleau JL;STICHES Investigators
在有冠状动脉疾病、心力衰竭和严重左心室收缩功能不全的患者中，将冠状动脉旁路移植术（CABG）加入指南指导的药物治疗与单独药物治疗相比，其生存获益尚不清楚。从2002年7月至2007年5月，共有1212例射血分数为35%或更低且冠状动脉疾病适合冠状动脉搭桥的患者被随机分配接受冠状动脉搭桥加药物治疗（冠状动脉搭桥组，610例）或单独药物治疗（药物治疗组，602例）。主要结果是任何原因导致的死亡。主要次要结局包括心血管原因死亡、任何原因死亡或因心血管原因住院。中位随访时间，包括目前的延长随访研究，为9.8年。CABG组有359例（58.9%）患者发生主要结局事件，药物治疗组有398例（66.1%）患者发生主要结局事件（CABG与药物治疗的风险比为0.84；95%可信区间[CI]， 0.73 ~ 0.97； log-rank检验P = 0.02）。CABG组共有247例（40.5%）患者死于心血管原因，药物治疗组有297例（49.3%）患者死于心血管原因（风险比0.79;95% CI 0.66 ~ 0.93； log-rank检验P = 0.006）。CABG组有467例（76.6%）患者死于任何原因或因心血管原因住院，药物治疗组有524例（87.0%）患者死于任何原因（风险比0.72;95% CI, 0.64 ~ 0.82； log-rank检验P<0.001）。在缺血性心肌病患者队列中，在接受药物治疗的同时接受冠脉搭桥的患者中，10年内任何原因的死亡率、心血管原因的死亡率以及心血管原因的死亡率或住院率明显低于单独接受药物治疗的患者。（由美国国立卫生研究院资助；STICH[和STICHES] ClinicalTrials.gov号码，NCT00023595。）
The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P = 0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P = 0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.)