From controlled trials to clinical practice: Monitoring transmyocardial revascularization use and outcomes
From controlled trials to clinical practice: Monitoring transmyocardial revascularization use and outcomes
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DOI：
10.1016/j.jacc.2003.07.003
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发表时间：
2003-11-05
影响因子：
24
通讯作者：
Ferguson, TB
中科院分区：
文献类型：
--
作者：
Peterson, ED;Kaul, P;Ferguson, TB
目的 我们试图研究社区实践中经心肌血运重建 (TMR) 的使用和结果趋势。我们还确定了 TMR 的重要危险因素，并比较了接受不完全血运重建的患者中 TMR 联合冠状动脉旁路移植手术 (TMR + CABG) 与单独搭桥的结果。 背景 虽然它被批准用作独立手术，但 (TMR + CABG) 的结果数据有限。 方法 我们确定了参加美国胸外科医师协会 (STS) 国家胸外科医师协会 (STS) 的 173 家美国医院的 3,717 名接受 TMR 的患者。心脏数据库。将这些患者的基线特征和结果与六项已发表的随机 TMR 试验进行比较。使用多变量逻辑回归来确定 TMR 死亡的临床危险因素。还比较了 TMR + CABG 相对于 CABG 的风险调整死亡率，仅适用于不适合完成传统血运重建的患者。 结果 1998 年 1 月至 2001 年 12 月期间，进行 TMR 的 STS 医院数量和总手术计数显着增加，这主要是由于更多的 TMR + CABG 病例。单独 TMR 和 TMR + CABG 的总体死亡率分别为 6.4% 和 4.2%。近期患有心肌梗塞、不稳定心绞痛和心室功能低下的患者的手术风险显着更高。在接受不完全血运重建的患者中，与单独 CABG 相比，TMR + CABG 与死亡风险降低无关，调整后的比值比为 1.11（95% 置信区间 0.74 至 1.67）。 结论 TMR，特别是 TMR + CABG 在社区实践中的使用正在扩大。尽管手术风险很高，但通过改进患者选择和手术时间安排仍有优化的空间。鉴于 TMR + CABG 的使用不断增加且益处尚不明确，因此需要对其进行进一步研究。 (C) 2003 年由美国心脏病学会基金会资助。
OBJECTIVES We sought to examine trends in the use and outcomes of transmyocardial revascularization (TMR) in community practice. We also identified important risk factors for TMR and compared outcomes of TMR combined with coronary artery bypass graft surgery (TMR + CABG) versus bypass alone in patients receiving incomplete revascularization.BACKGROUND Although it is approved for use as a stand-alone procedure, there are limited data on the outcomes of (TMR + CABG).METHODS We identified 3,717 patients receiving TMR at 173 U.S. hospitals participating in the Society of Thoracic Surgeons (STS) National Cardiac Database. Baseline characteristics and outcomes in these patients were compared with those from six published randomized TMR trials. Multivariable logistic regression was used to identify clinical risk factors for mortality with TMR. Risk-adjusted mortality was also compared for TMR + CABG relative to CABG only in patients not amenable to complete traditional revascularization.RESULTS Between January 1998 and December 2001, the number of STS hospitals performing TMR and total procedural counts increased markedly, driven predominately by more TMR + CABG cases. Overall mortality rates for TMR-alone and TMR + CABG were 6.4% and 4.2%, respectively. Operative risks were significantly higher in those patients with recent myocardial infarction, unstable angina, and depressed ventricular function. Among patients receiving incomplete revascularization, TMR + CABG was not associated with decreased mortality risk compared with CABG alone, adjusted odds ratio 1.11 (95% confidence interval 0.74 to 1.67).CONCLUSIONS The use of TMR, and in particular, TMR + CABG, is expanding in community practice. Although procedural risks are high, there is room for optimization through improved patient selection and timing of the procedure. Further studies of TMR + CABG are needed given its growing use and unclear benefits. (C) 2003 by the American College of Cardiology Foundation.