Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Thorac Cardiovasc Surg. 2014 Jun;147(6):1868-74, 1874.e1-2. doi: 10.1016/j.jtcvs.2013.06.036. Epub 2013 Aug 19.
Surgical ventricular reconstruction has been believed to be beneficial for those with ischemic cardiomyopathy. However, the effectiveness of surgical ventricular reconstruction was not proved by a large-scale trial, and no report has clearly demonstrated the exact indications and limitations of surgical ventricular reconstruction. The purpose of this study was to elucidate predictive factors of mortality after surgical ventricular reconstruction and to develop a prognostic model by calculating risk scores.
The study subjects were 596 patients who underwent surgical ventricular reconstruction for chronic ischemic heart failure in 11 Japanese cardiovascular hospitals between 2000 and 2010. Potential predictors of postoperative mortality were assessed using the Cox proportional hazards model, and a risk score was calculated.
Forty-one patients died before discharge, and 81 patients died during a mean follow-up time of 2.9 years. Four independent predictors of mortality were identified: age, Interagency Registry for Mechanically Assisted Circulatory Support profile, left ventricular ejection fraction, and severity of mitral regurgitation. Each variable was assigned a number of points proportional to its regression coefficient. A risk score was calculated using the point scores for each patient, and 3 risk groups were developed: a low-risk group (0-4 points), an intermediate-risk group (5-6 points), and a high-risk group (7-12 points). Their 3-year survivals were 93%, 81%, and 44%, respectively (log-rank P < .001). Harrell's C-index of the predictive model was 0.69.
A simple prognostic model was developed to predict mortality after surgical ventricular reconstruction. It can be useful in clinical practice to select treatment options for ischemic heart failure.
外科心室重构术被认为对缺血性心肌病患者有益。然而，一项大规模试验并未证明外科心室重构术的有效性，也没有报告明确显示外科心室重构术的确切适应证和局限性。本研究旨在阐明外科心室重构术后死亡的预测因素，并通过计算风险评分来建立预后模型。
本研究对象为 2000 年至 2010 年间，11 家日本心血管医院因慢性缺血性心力衰竭而行外科心室重构术的 596 例患者。使用 Cox 比例风险模型评估术后死亡的潜在预测因素，并计算风险评分。
41 例患者在出院前死亡，81 例患者在平均 2.9 年的随访期间死亡。确定了 4 个死亡的独立预测因素：年龄、机械循环支持机构间注册登记、左心室射血分数和二尖瓣反流严重程度。每个变量都被赋予与其回归系数成比例的分数。使用每个患者的点分数计算风险评分，并将患者分为 3 个风险组：低危组（0-4 分）、中危组（5-6 分）和高危组（7-12 分）。他们的 3 年生存率分别为 93%、81%和 44%（对数秩 P<0.001）。预测模型的 Harrell C 指数为 0.69。
建立了一种简单的预后模型来预测外科心室重构术后的死亡率。它可以在临床实践中用于选择缺血性心力衰竭的治疗方案。
