Libin Cardiovascular Institute and University of Calgary Medical Centre, Calgary, Canada.
Duke Clinical Research Institute and Department of Biostatistics and Bioinformatics, Durham, North Carolina.
JACC Heart Fail. 2019 Oct;7(10):878-887. doi: 10.1016/j.jchf.2019.04.018. Epub 2019 Sep 11.
The authors investigated the impact of coronary artery bypass grafting (CABG) on first and recurrent hospitalization in this population.
In the STICH (Surgical Treatment for Ischemic Heart Failure) trial, CABG reduced all-cause death and hospitalization in patients with and ischemic cardiomyopathy and left ventricular ejection fraction <35%.
A total of 1,212 patients were randomized (610 to CABG + optimal medical therapy [CABG] and 602 to optimal medical therapy alone [MED] alone) and followed for a median of 9.8 years. All-cause and cause-specific hospitalizations were analyzed as time-to-first-event and as recurrent event analysis.
Of the 1,212 patients, 757 died (62.4%) and 732 (60.4%) were hospitalized at least once, for a total of 2,549 total all-cause hospitalizations. Most hospitalizations (66.2%) were for cardiovascular causes, of which approximately one-half (907 or 52.9%) were for heart failure. More than 70% of all hospitalizations (1,817 or 71.3%) were recurrent events. The CABG group experienced fewer all-cause hospitalizations in the time-to-first-event (349 CABG vs. 383 MED, adjusted hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74 to 0.98; p = 0.03) and in recurrent event analyses (1,199 CABG vs. 1,350 MED, HR: 0.78, 95% CI: 0.65 to 0.94; p < 0.001). This was driven by fewer total cardiovascular (CV) hospitalizations (744 vs. 968; p < 0.001, adjusted HR: 0.66, 95% CI: 0.55 to 0.81; p = 0.001), the majority of which were due to HF (395 vs. 512; p < 0.001, adjusted HR: 0.68, 95% CI: 0.52-0.89; p = 0.005). We did not observe a difference in non-CV events.
CABG reduces all-cause, CV, and HF hospitalizations in time-to-first-event and recurrent event analyses. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595).
作者研究了在这一人群中，冠状动脉旁路移植术（CABG）对首次和再次住院的影响。
在 STICH（缺血性心力衰竭的外科治疗）试验中，CABG 降低了缺血性心肌病和左心室射血分数<35%的患者的全因死亡和住院率。
共有 1212 名患者被随机分配（610 名接受 CABG+最佳药物治疗[CABG]，602 名仅接受最佳药物治疗[MED]），并随访中位数为 9.8 年。全因和病因特异性住院情况作为首次事件时间和复发性事件分析进行分析。
在 1212 名患者中，757 人死亡（62.4%），732 人（60.4%）至少住院一次，共有 2549 例全因住院。大多数住院（66.2%）是心血管原因，其中约一半（907 例，52.9%）是心力衰竭。超过 70%的住院（1817 例，71.3%）是复发性事件。CABG 组首次事件时间（349 例 CABG 与 383 例 MED，调整后的危险比[HR]：0.85；95%置信区间[CI]：0.74 至 0.98；p=0.03）和复发性事件分析（1199 例 CABG 与 1350 例 MED，HR：0.78，95%CI：0.65 至 0.94；p<0.001）中全因住院次数较少。这归因于心血管（CV）总住院次数减少（744 例与 968 例；p<0.001，调整后的 HR：0.66，95%CI：0.55 至 0.81；p=0.001），其中大多数是心力衰竭（395 例与 512 例；p<0.001，调整后的 HR：0.68，95%CI：0.52-0.89；p=0.005）。我们没有观察到非 CV 事件的差异。
CABG 降低首次事件时间和复发性事件分析中的全因、CV 和 HF 住院率。（充血性心力衰竭和冠状动脉疾病的外科治疗与药物治疗比较[STICH]；NCT00023595）。
