Coronary-artery bypass surgery in patients with left ventricular dysfunction.
Coronary-artery bypass surgery in patients with left ventricular dysfunction.
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DOI：
10.1056/nejmoa1100356
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发表时间：
2011-04-28
期刊：
影响因子：
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通讯作者：
STICH Investigators
中科院分区：
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作者：
Velazquez EJ;Lee KL;Deja MA;Jain A;Sopko G;Marchenko A;Ali IS;Pohost G;Gradinac S;Abraham WT;Yii M;Prabhakaran D;Szwed H;Ferrazzi P;Petrie MC;O'Connor CM;Panchavinnin P;She L;Bonow RO;Rankin GR;Jones RH;Rouleau JL;STICH Investigators
冠状动脉旁路移植术（CABG）在治疗冠状动脉疾病和心力衰竭患者中的作用尚未明确。在2002年7月至2007年5月期间，共有1212例射血分数为35%或更低且冠状动脉疾病适合CABG的患者被随机分配至单独药物治疗（602例患者）或药物治疗加CABG（610例患者）。主要结局是任何原因的死亡率。主要次要结局包括心血管原因死亡率和任何原因死亡率或因心血管原因住院率。药物治疗组有244例患者（41%）发生主要结局，CABG组有218例患者（36%）发生主要结局（CABG的风险比为0.86; 95%置信区间[CI]为0.72 - 1.04; P = 0.12）。药物治疗组共有201名患者（33%），CABG组共有168名患者（28%）死于判定的心血管原因（CABG的风险比为0.81; 95%CI为0.66 - 1.00; P = 0.05）。药物治疗组有411例（68%）患者死于任何原因或因心血管原因住院，CABG组有351例（58%）患者死于任何原因或因心血管原因住院（CABG组的风险比为0.74; 95%CI为0.64 ~ 0.85; P<0.001）。在随访期结束时（中位数，56个月），药物治疗组有100例患者（17%）接受了CABG，CABG组有555例患者（91%）接受了CABG。在这项随机试验中，单用药物治疗和药物治疗加CABG在主要终点（全因死亡）方面没有显著差异。与仅接受药物治疗的患者相比，接受CABG的患者心血管原因死亡率和任何原因死亡率或因心血管原因住院率较低。（由国家心肺血液研究所和雅培实验室资助;斯蒂奇ClinicalTrials.gov编号，NCT 00023595。）
The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. Between July 2002 and 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 medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P = 0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.)