慢性肾脏病患者双侧内乳动脉桥的疗效。
Efficacy of bilateral internal thoracic artery grafting in patients with chronic kidney disease.
机构信息
Division of Cardiovascular Surgery, Department of Health Statistics, Shiga University of Medical Science, Setatsukinowa, Otsu, Japan.
出版信息
Ann Thorac Surg. 2010 Apr;89(4):1106-11. doi: 10.1016/j.athoracsur.2009.12.025.
BACKGROUND
This study compared short-term and long-term outcomes in propensity score-matched patients with chronic kidney disease receiving bilateral internal thoracic artery (ITA) or single ITA grafting and assessed any benefit of bilateral ITA grafting for survival.
METHODS
Among 656 consecutive patients undergoing isolated coronary artery bypass grafting (99.1% by off-pump technique) between 2002 and 2008, 361 had chronic kidney disease with no history of dialysis. After excluding 10 patients who would not be potential candidates for bilateral ITA grafting because they were aged older than 85 years and 15 who had only one target vessel at the left coronary area, we identified 157 propensity score-matched pairs. Propensity scores were created based on 13 preoperative factors (C statistics, 0.787).
RESULTS
During a mean observation of 2.9 years, the rates of overall death and cardiac death (myocardial infarction, heart failure, and sudden death) in the bilateral ITA group were significantly lower than those in the single ITA group (5.1% vs 15.9%, p=0.01; 1.3% vs 8.3%, p=0.01). In multivariate Cox models including bilateral ITA grafting and all other potential predictors, bilateral ITA grafting was significantly associated with a lower risk for overall death (hazard ratio, 0.29; 95% confidence interval, 0.10 to 0.89; p=0.03) and cardiac death (hazard ratio, 0.14; 95% confidence interval, 0.03 to 0.63; p=0.02).
CONCLUSIONS
Among patients with chronic kidney disease, bilateral ITA grafting provides better long-term survival than single ITA grafting.
背景
本研究比较了慢性肾脏病患者接受双侧内乳动脉（ITA）或单支 ITA 移植的短期和长期结果，并评估了双侧 ITA 移植对生存的任何益处。
方法
在 2002 年至 2008 年间连续进行的 656 例单纯冠状动脉旁路移植术（99.1%采用非体外循环技术）患者中，有 361 例患有慢性肾脏病且无透析史。排除 10 例年龄大于 85 岁且左侧冠状动脉仅有一支靶血管的患者后，又排除 15 例因不适合双侧 ITA 移植的患者（总共 25 例），我们确定了 157 对匹配的病例。根据 13 个术前因素（C 统计，0.787）建立了倾向性评分。
结果
在平均 2.9 年的随访中，双侧 ITA 组的总死亡率和心脏死亡率（心肌梗死、心力衰竭和猝死）明显低于单支 ITA 组（5.1%比 15.9%，p=0.01；1.3%比 8.3%，p=0.01）。在包括双侧 ITA 移植和所有其他潜在预测因素的多变量 Cox 模型中，双侧 ITA 移植与降低总死亡率（风险比，0.29；95%置信区间，0.10 至 0.89；p=0.03）和心脏死亡率（风险比，0.14；95%置信区间，0.03 至 0.63；p=0.02）显著相关。
结论
在慢性肾脏病患者中，双侧 ITA 移植比单支 ITA 移植提供更好的长期生存率。
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