Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization
Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization
复制标题
DOI：
10.1016/j.ijcard.2005.06.035
复制
发表时间：
2006-07-28
影响因子：
3.5
通讯作者：
Iliceto, Sabino
中科院分区：
文献类型：
--
作者：
Buja, Paolo;Tarantini, Giuseppe;Iliceto, Sabino
背景：中重度缺血性二尖瓣返流伴多支冠状动脉疾病的结局仍有争议。我们分析了不同的治疗方法，即药物治疗（MT）、单纯冠状动脉旁路移植术（CABG）和CABG合并二尖瓣手术（MVS）对这些患者生存和再住院的影响。方法：1990年至2002年，我们确定了III个连续的患者，年龄73 8岁，在无原发性瓣膜疾病的情况下，心导管检查显示慢性中度至重度二尖瓣返流和多支冠状动脉疾病。NIT组22例，CABG组50例，CABG+MVS组39例。总体而言，临床和超声心动图随访的中位时间分别为34.9个月和14.6个月。组间差异显著左室舒张末期容积指数（P < 0.03）（NIT 153 54，CABG 125 35，CABG+MVS 129 38，m1/m2）、射血分数（NIT 35 14，CABG 38 13，CABG+MVS 50+14，%）和乳房动脉移植物使用（CABG 60，CABG + MVS 74，%）。虽然外科手术患者的住院死亡率较高（MT 13.6，CABG 18，CABG + MVS 17.9，%，p = 0.09），但与其他组相比，7年死亡率显示出有利于CABG + MVS的趋势（NIT 100，CABG 57，CABG + MVS 29，%，p 0.1）。在调整基线差异后，与MT相比，单独CABG或与MVS联合CABG的心源性死亡和再住院率风险降低了57%（HR 0.43，p = 0.005）和53%（HR 0.47，p = 0.02）。然而，只有CABG+MVS独立预测死亡率（风险降低65%，HR 0.35，p = 0.027）。结论：在中度至重度缺血性二尖瓣返流和多支冠状动脉疾病，手术减少总的心脏事件，但只有伴随MVS显着提高生存率。(c)2005爱思唯尔爱尔兰有限公司保留所有权利。
Background: The outcome of moderate-to-severe ischemic mitral regurgitation with multivessel coronary artery disease is still debated. We analysed the effect of different treatments, i.e. medical therapy (MT), coronary artery by-pass grafting (CABG) alone and CABG with mitral valve surgery (MVS), on the survival and rehospitalization of these patients.Methods: Between 1990 and 2002, we identified III consecutive patients, aged 73 8 years, with chronic moderate-to-severe mitral regurgitation and multivessel coronary artery disease at cardiac catheterization, in absence of primary valve disease. Twenty-two patients were treated by NIT, 50 by CABG and 39 by CABG+MVS. Overall, the median clinical and echocardiographic follow-ups were 34.9 and 14.6 months, respectively.Results: Groups differed significantly (p < 0.03) for left ventricular end-diastolic volume index (NIT 153 54, CABG 125 35, CABG+MVS 129 38, m1/m2), ejection fraction (NIT 35 14, CABG 38 13, CABG+MVS 50+14, %) and mammary artery graft use (CABG 60, CABG + MVS 74, %). While in-hospital mortality was higher in surgical patients (MT 13.6, CABG 18, CABG + MVS 17.9, %, p = 0.09), 7-years mortality showed a trend in favour of CABG + MVS compared to other groups (NIT 100, CABG 5 7, CABG + MVS 29, %, p 0.1). After adjusting for baseline differences, CABG alone or with MVS had a 5 7% (HR 0.43, p = 0.005) and 53 % (HR 0.47, p = 0.02) risk reduction of combined cardiac death and rehospitalization rate compared to MT. However, only CABG+MVS independently predicted mortality (risk reduction 65%, HR 0.35, p = 0.027).Conclusions: In moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease, surgery reduced total cardiac events but only a concomitant MVS significantly improved survival. (c) 2005 Elsevier Ireland Ltd. All rights reserved.