左心室功能障碍患者的冠状动脉旁路手术。
Coronary-artery bypass surgery in patients with left ventricular dysfunction.
机构信息
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, NC, USA.
出版信息
N Engl J Med. 2011 Apr 28;364(17):1607-16. doi: 10.1056/NEJMoa1100356. Epub 2011 Apr 4.
BACKGROUND
The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.
METHODS
Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
RESULTS
The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG.
CONCLUSIONS
In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.).
背景
冠状动脉旁路移植术（CABG）在治疗冠心病合并心力衰竭患者中的作用尚未明确。
方法
2002 年 7 月至 2007 年 5 月，共纳入 1212 例射血分数为 35%或更低且适合行 CABG 的冠心病患者，随机分为单纯药物治疗组（602 例）或药物治疗加 CABG 组（610 例）。主要终点为任何原因导致的死亡率。主要次要终点包括心血管原因导致的死亡率、任何原因导致的死亡率以及因心血管原因住院的发生率。
结果
药物治疗组 244 例（41%）和 CABG 组 218 例（36%）患者发生主要终点事件（CABG 组的风险比为 0.86；95%置信区间为 0.72 至 1.04；P=0.12）。药物治疗组 201 例（33%）和 CABG 组 168 例（28%）患者死于心血管原因（CABG 组的风险比为 0.81；95%置信区间为 0.66 至 1.00；P=0.05）。药物治疗组 411 例（68%）和 CABG 组 351 例（58%）患者发生任何原因或心血管原因住院（CABG 组的风险比为 0.74；95%置信区间为 0.64 至 0.85；P<0.001）。随访结束时（中位时间为 56 个月），药物治疗组有 100 例（17%）患者接受了 CABG，CABG 组有 555 例（91%）患者接受了 CABG。
结论
在这项随机试验中，单独药物治疗与药物治疗加 CABG 治疗在任何原因导致的死亡这一主要终点方面没有显著差异。与单独药物治疗相比，接受 CABG 的患者心血管原因导致的死亡率以及任何原因导致的死亡率或心血管原因住院的发生率更低。（由美国国立心肺血液研究所和雅培实验室资助；STICH ClinicalTrials.gov 编号：NCT00023595）。
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