冠状动脉旁路移植术中单支与多支动脉移植物的长期生存比较。
Long-term survival after coronary bypass surgery with multiple versus single arterial grafts.
机构信息
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany.
出版信息
Eur J Cardiothorac Surg. 2022 Mar 24;61(4):925-933. doi: 10.1093/ejcts/ezab392.
OBJECTIVES
This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study.
METHODS
The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed.
RESULTS
Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles.
CONCLUSIONS
In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy.
TRIAL REGISTRATION
SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.
目的
本研究旨在评估 SYNTAX 研究中接受冠状动脉旁路移植术（CABG）的患者中，多动脉移植物（MAG）与单动脉移植物（SAG）在长期生存方面的差异。
方法
本分析纳入了 SYNTAX 扩展生存研究（SYNTAXES）中的随机和注册治疗的 CABG 患者（n=1509）。排除仅使用静脉（n=42）或合成移植物（n=1）的患者。主要终点是最长随访期间的全因死亡。使用多变量 Cox 回归调整基线特征差异。使用治疗权重逆概率进行倾向匹配的敏感性分析。
结果
在纳入的 1466 例患者中，465 例（31.7%）接受 MAG，1001 例（68.3%）接受 SAG。接受 MAG 的患者年龄较小且风险较低。在最长随访 12.6 年时，MAG 组和 SAG 组的全因死亡率分别为 23.6%和 40.0%[调整后的危险比（HR）0.74，95%置信区间（CI）（0.55-0.98）；P=0.038]，该结果在敏感性分析中得到证实。对于三血管疾病患者，MAG 与未经调整和调整后的 12.6 年全因死亡风险显著降低相关[调整后的 HR 0.65，95%CI（0.44-0.97）；P=0.033]。然而，在左主干疾病、有或无糖尿病以及 SYNTAX 评分三分位的患者中，经过风险调整后，这种差异不再显著。
结论
在 SYNTAX 试验的所有患者的本次事后分析中，与 SAG 策略相比，MAG 显著降低了 12.6 年时的全因死亡率。因此，MAG 与 SAG 相比在长期生存方面具有显著优势，这鼓励在预期寿命合理的患者中更广泛地使用多动脉移植物。
试验注册
SYNTAXES ClinicalTrials.gov 参考号：NCT03417050；SYNTAX ClinicalTrials.gov 参考号：NCT00114972。
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