Buszman Paweł, Szkróbka Iwona, Gruszka Agata, Parma Radosław, Tendera Zofia, Leśko Blanka, Wilczyński Mirosław, Bochenek Tomasz, Wojakowski Wojciech, Bochenek Andrzej, Tendera Michał
Third Division of Cardiology and Acute Coronary Care Unit, Silesian School of Medicine, Katowice, Poland.
Am J Cardiol. 2007 Jan 1;99(1):36-41. doi: 10.1016/j.amjcard.2006.07.056. Epub 2006 Nov 3.
The REvascularization in Ischemic HEart Failure Trial (REHEAT) is a nonrandomized, case-controlled, prospective study assessing the hypothesis that surgical and percutaneous revascularizations in patients with ischemic cardiomyopathy are associated with comparable improvement in left ventricular ejection fraction (LVEF) and functional status 12 months after myocardial revascularization. The study population consisted of 141 patients with LVEFs of <40% and angiographically confirmed coronary artery disease. The primary end point was improvement in LVEF 12 months after intervention. Secondary end points were in-hospital major adverse events, length of hospitalization, exercise tolerance of treadmill stress testing after 12 months, 1-year survival, 1-year event-free survival, angina, and heart failure severity after 12 months. The case-controlled study included 55 patients who underwent percutaneous coronary intervention (PCI) and 54 who underwent coronary artery bypass grafting (CABG). The incidence of 30-day major adverse events was higher in the CABG group (40.7% vs 9%, p = 0.0003), whereas duration of hospital stay was shorter in the PCI group (6.8 +/- 3.6 vs 9.2 +/- 2.1 days, p = 0.00001). Increase in LVEF was comparable after PCI and CABG (6.0 +/- 7.2% vs 4.4 +/- 9.0% p = 0.12). Long-term functional status based on treadmill stress testing was better after PCI (Student's t test, p = 0.0003) but, according to Canadian Cardiovascular Society and New York Heart Association classifications, was similar in the 2 treatment arms (Wilcoxon test, p <0.01). Long-term survival was significantly better for patients after PCI (Wilcoxon test, p <0.01); however, major adverse event-free survival was better after CABG (Cox-Mantel test, p = 0.0013). In conclusion, PCI and CABG are associated with comparable improvements in LVEF in patients with ischemic cardiomyopathy. PCI offers a better 1-year survival rate than CABG, but the incidence of repeat revascularization is lower with CABG.
缺血性心力衰竭血管重建试验（REHEAT）是一项非随机、病例对照的前瞻性研究，旨在评估以下假设：缺血性心肌病患者接受外科手术和经皮血管重建术后，左心室射血分数（LVEF）和功能状态在心肌血运重建术后12个月有相似程度的改善。研究人群包括141例LVEF<40%且经血管造影证实患有冠状动脉疾病的患者。主要终点是干预后12个月LVEF的改善情况。次要终点包括住院期间的主要不良事件、住院时间、12个月后跑步机压力测试的运动耐量、1年生存率、1年无事件生存率、心绞痛以及12个月后的心力衰竭严重程度。该病例对照研究包括55例行经皮冠状动脉介入治疗（PCI）的患者和54例行冠状动脉旁路移植术（CABG）的患者。CABG组30天主要不良事件的发生率更高（40.7%对9%，p = 0.0003），而PCI组的住院时间更短（6.8±3.6天对9.2±2.1天，p = 0.00001）。PCI和CABG术后LVEF的增加相当（6.0±7.2%对4.4±9.0%，p = 0.12）。基于跑步机压力测试的长期功能状态在PCI术后更好（学生t检验，p = 0.0003），但根据加拿大心血管学会和纽约心脏协会的分类，两个治疗组相似（Wilcoxon检验，p<0.01）。PCI术后患者的长期生存率明显更好（Wilcoxon检验，p<0.01）；然而，CABG术后无主要不良事件生存率更好（Cox-Mantel检验，p = 0.0013）。总之，PCI和CABG在缺血性心肌病患者中与LVEF的相似改善相关。PCI的1年生存率优于CABG，但CABG的再次血管重建发生率更低。
