Effect of Revascularization on Long-Term Survival in Patients With Ischemic Left Ventricular Dysfunction and a Wide Range of Viability
Effect of Revascularization on Long-Term Survival in Patients With Ischemic Left Ventricular Dysfunction and a Wide Range of Viability
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DOI：
10.1016/j.amjcard.2010.03.014
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发表时间：
2010-07-15
影响因子：
2.8
通讯作者：
Feigenbaum, Harvey
中科院分区：
文献类型：
--
作者：
Sawada, Stephen G.;Dasgupta, Saumyadip;Feigenbaum, Harvey
存活和缺血性左心室功能不全患者的短期生存率似乎通过血运重建得到改善，但没有随机研究表明血运重建对存活能力广泛的患者有长期益处。在一项比较缺血性功能障碍患者血运重建和药物治疗的生存率的研究中，倾向分析被用作随机化的替代。对274例缺血性左心室功能不全（平均射血分数32%）患者进行多巴酚丁胺超声心动图检查，其中32%的患者存活心肌≥ 25%。除多支血管疾病、高脂血症和无活力心肌百分比外，两个治疗组的临床、血管造影和超声心动图特征相似。从基线变量中推导出每例患者的倾向评分，反映接受血运重建的概率。按倾向评分分层后，组间无差异。随访患者的心源性死亡。130名患者进行了血运重建，144名患者接受了药物治疗。在4.5年的随访中，有114例（42%）心源性死亡。倾向评分调整后，血运重建的生存率更高（平均生存期5.9年vs 3.3年，风险比0.42，95%置信区间0.27 - 0.65，p
Short-term survival in patients with viability and ischemic left ventricular dysfunction appears improved by revascularization, but no randomized studies have shown a long-term benefit of revascularization in patients with a wide range of viability. Propensity analysis was used as a substitute for randomization in a study comparing the survival of revascularized and medically treated patients with ischemic dysfunction. Dobutamine echocardiography was performed in 274 patients with ischemic left ventricular dysfunction (mean ejection fraction 32%), with 32% having viability in >= 25% of the myocardium. Clinical, angiographic, and echocardiographic characteristics were comparable between treatment groups except for multivessel disease, hyperlipidemia, and the percentage of nonviable myocardium. A propensity score, reflecting the probability of receiving revascularization, was derived for each patient from baseline variables. After stratification by propensity scores, there were no differences between groups. Patients were followed for cardiac death. Revascularization was performed in 130 patients, and 144 were medically treated. There were 114 cardiac deaths (42%) over 4.5 years of follow-up. After propensity score adjustment, survival was better with revascularization (mean survival 5.9 vs 3.3 years, hazard ratio 0.42, 95% confidence interval 027 to 0.65, p