Lim Eric, Ali Ziad, Ali Ayyaz, Motalleb-Zadeh Reza, Jackson Christopher, Ong Seok Ling, Halstead James, Sharples Linda, Parameshwar Jayan, Wallwork John, Large Stephen R
Transplant Unit, Papworth Hospital, Cambridge, UK.
J Heart Lung Transplant. 2005 Aug;24(8):983-9. doi: 10.1016/j.healun.2004.05.027.
To ascertain survival of ischemic advanced heart failure patients by treatment allocation, we examined the outcome of transplant assessment patients allocated to medical therapy, high-risk conventional surgery, or transplantation.
Patients were identified from the Papworth transplant database and excluded if primary etiology was not ischemic. Grouping was undertaken according to treatment allocation at initial assessment, and analysis was performed by intention to treat. Survival was computed from the time of assessment and Cox regression used to stratify patients according risk with the Heart Failure Survival Score.
From May 1993 to September 2001, a total of 755 patients were admitted for transplant assessment, with 348 (46.1%) identified as having heart failure of ischemic origin. Variables required for calculation of the Heart Failure Survival Score was available in 273 patients (78.4%), and 20 patients (7.3%) were lost to follow-up. Of the remaining 253 patients, 89 (35.2%) were allocated to medical therapy, 32 (12.6%) to surgery, and 132 (52.2%) to transplantation. The relative risk (95% confidence limit) of death compared with medical therapy was 0.62 (0.28, 1.40) for surgery and 0.38 (0.24, 0.61) for transplantation in medium- to high-risk patients. For low-risk patients, the relative risks for death compared with medical therapy were 1.87 (0.63, 5.60) for surgery and 1.97 (0.79, 4.96) for transplantation.
Transplantation improved survival of medium- and high-risk patients compared with medical therapy. In the low-risk group, this was not evident. However, repeated assessment of risk is required because the hazard for death rises steadily after the third year in these patients.
为了通过治疗分配确定缺血性晚期心力衰竭患者的生存率，我们研究了被分配接受药物治疗、高风险传统手术或移植的移植评估患者的结局。
从帕普沃思移植数据库中识别患者，若原发性病因不是缺血性的则排除。根据初次评估时的治疗分配进行分组，并采用意向性分析。从评估时间开始计算生存率，并使用心力衰竭生存评分通过Cox回归对患者进行风险分层。
1993年5月至2001年9月，共有755例患者因移植评估入院，其中348例（46.1%）被确定为缺血性心力衰竭。273例患者（78.4%）可获得计算心力衰竭生存评分所需的变量，20例患者（7.3%）失访。在其余253例患者中，89例（35.2%）被分配接受药物治疗，32例（12.6%）接受手术治疗，132例（52.2%）接受移植治疗。中高危患者与药物治疗相比，手术治疗的死亡相对风险（95%置信区间）为0.62（0.28，1.40），移植治疗为0.38（0.24，0.61）。对于低风险患者，与药物治疗相比，手术治疗的死亡相对风险为1.87（0.63，5.60），移植治疗为1.97（0.79，4.96）。
与药物治疗相比，移植治疗提高了中高危患者的生存率。在低风险组中，这并不明显。然而，由于这些患者在第三年后死亡风险稳步上升，因此需要反复评估风险。
