Trichon Benjamin H, Glower Donald D, Shaw Linda K, Cabell Christopher H, Anstrom Kevin J, Felker G Michael, O'Connor Christopher M
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Circulation. 2003 Sep 9;108 Suppl 1:II103-10. doi: 10.1161/01.cir.0000087656.10829.df.
The most appropriate treatment for patients with ischemic mitral regurgitation (IMR) is often debated. We compared the survival rates of patients with IMR undergoing different treatment strategies, namely: medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and CABG + mitral valve (MV) surgery.
Patients undergoing catheterization between 1986 and 2001 were included. IMR was defined as: >or=grade 2+ mitral regurgitation (MR) and significant coronary artery disease (CAD) without primary mitral valve disease. Patients undergoing catheterization for the evaluation of congenital or other valvular heart disease were excluded. Multivariable Cox proportional hazards modeling was utilized to assess the independent relation between treatment and survival. Propensity score methods were used to correct for the nonrandom assignment of treatment. Of the 2,757 patients who met study criteria: 1,305 were treated medically, 537 underwent PCI, 687 underwent CABG, and 228 underwent CABG + MV surgery. The median duration of follow-up was 3.2 (0.9, 7.1) years. Patients undergoing CABG + MV surgery had more severe MR and more severe heart failure than those treated by other modalities. After adjusting for differences in baseline characteristics, patients undergoing PCI, CABG, and CABG + MV surgery had a 31% (hazards ratio [HR]=0.69; P=0.0001), 42% (HR=0.58; P=0.0001), and 42% (HR=0.58; P=0.0001) reduction in the risk of death, respectively, compared with those undergoing medical therapy. The performance of mitral valve surgery with CABG was not associated with improved survival versus CABG alone (P=0.258).
Among patients with IMR, treatment with PCI, CABG, or CABG + MV surgery is associated with improved survival compared with medical therapy.
缺血性二尖瓣反流（IMR）患者的最佳治疗方案一直存在争议。我们比较了接受不同治疗策略的IMR患者的生存率，这些策略包括：药物治疗、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）以及CABG + 二尖瓣（MV）手术。
纳入1986年至2001年间接受导管插入术的患者。IMR定义为：二尖瓣反流（MR）≥2+级且伴有严重冠状动脉疾病（CAD），无原发性二尖瓣疾病。排除因评估先天性或其他瓣膜性心脏病而接受导管插入术的患者。采用多变量Cox比例风险模型评估治疗与生存之间的独立关系。倾向评分法用于校正治疗的非随机分配。在符合研究标准的2757例患者中：1305例接受药物治疗，537例接受PCI，687例接受CABG，228例接受CABG + MV手术。中位随访时间为3.2（0.9，7.1）年。接受CABG + MV手术的患者比接受其他治疗方式的患者有更严重的MR和更严重的心力衰竭。在调整基线特征差异后，与接受药物治疗的患者相比，接受PCI、CABG和CABG + MV手术的患者死亡风险分别降低了31%（风险比[HR]=0.69；P = 0.0001）、42%（HR = 0.58；P = 0.0001）和42%（HR = 0.58；P = 0.0001）。与单纯CABG相比，CABG联合二尖瓣手术并未改善生存率（P = 0.258）。
在IMR患者中，与药物治疗相比，PCI、CABG或CABG + MV手术治疗可提高生存率。
