完全血运重建在缺血性心肌病冠状动脉旁路移植术中的影响。
Impact of complete revascularization in coronary artery bypass grafting for ischemic cardiomyopathy.
作者信息
Nakae Masaro, Kainuma Satoshi, Toda Koichi, Yoshikawa Yasushi, Hata Hiroki, Yoshioka Daisuke, Kawamura Takuji, Kawamura Ai, Kashiyama Noriyuki, Ueno Takayoshi, Kuratani Toru, Kondoh Haruhiko, Hiraoka Arudo, Sakaguchi Taichi, Yoshitaka Hidenori, Shirakawa Yukitoshi, Takahashi Toshiki, Sakaki Masayuki, Masai Takafumi, Komukai Sho, Kitamura Tetsuhisa, Hirayama Atsushi, Shimomura Yoshimitsu, Miyagawa Shigeru
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Japan Organization of Occupational Health and Safety Osaka Rosai Hospital, Sakai, Osaka, Japan.
出版信息
JTCVS Open. 2023 Apr 20;15:211-219. doi: 10.1016/j.xjon.2023.04.008. eCollection 2023 Sep.
OBJECTIVE
In patients with ischemic cardiomyopathy, coronary artery bypass grafting ensures better survival than medical therapy. However, the long-term clinical impact of complete revascularization remains unclear. This observational study aimed to evaluate the effects of complete revascularization on long-term survival and left ventricular functional recovery in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting.
METHODS
We retrospectively reviewed outcomes of 498 patients with ischemic cardiomyopathy who underwent complete (n = 386) or incomplete (n = 112) myocardial revascularization between 1993 and 2015. The baseline characteristics were adjusted using inverse probability of treatment weighting to reduce the impact of treatment bias and potential confounding. The mean follow-up duration was 77.2 ± 42.8 months in survivors.
RESULTS
The overall 5-year survival rate (complete revascularization, 72.5% vs incomplete revascularization, 57.9%, = .03) and freedom from all-cause death and/or readmission due to heart failure (54.5% vs 40.1%, = .007) were significantly greater in patients with complete revascularization than those with incomplete revascularization. After adjustments using inverse probability of treatment weighting, the complete revascularization group demonstrated a lower risk of all-cause death (hazard ratio, 0.61; 95% confidence interval, 0.43-0.86; = .005) and composite adverse events (hazard ratio, 0.59; 95% confidence interval, 0.44-0.79; < .001) and a greater improvement in the left ventricular ejection fraction 1-year postoperatively (absolute change: 11.0 ± 11.9% vs 8.3 ± 11.4%, interaction effect = .05) than the incomplete revascularization group.
CONCLUSIONS
In patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting, complete revascularization was associated with better long-term outcomes and greater left ventricular functional recovery and should be encouraged whenever possible.
目的
在缺血性心肌病患者中，冠状动脉旁路移植术比药物治疗能确保更好的生存率。然而，完全血运重建的长期临床影响仍不明确。这项观察性研究旨在评估完全血运重建对接受冠状动脉旁路移植术的缺血性心肌病患者长期生存和左心室功能恢复的影响。
方法
我们回顾性分析了1993年至2015年间498例接受完全（n = 386）或不完全（n = 112）心肌血运重建的缺血性心肌病患者的结局。使用治疗权重的逆概率对基线特征进行调整，以减少治疗偏倚和潜在混杂因素的影响。幸存者的平均随访时间为77.2±42.8个月。
结果
完全血运重建患者的总体5年生存率（72.5%对不完全血运重建的57.9%，P = .03）以及无因全因死亡和/或因心力衰竭再次入院的比例（54.5%对40.1%，P = .007）显著高于不完全血运重建患者。在使用治疗权重的逆概率进行调整后，完全血运重建组的全因死亡风险较低（风险比，0.61；95%置信区间，0.43 - 0.86；P = .005）和复合不良事件风险较低（风险比，0.59；95%置信区间，0.44 - 0.79；P < .001），并且术后1年左心室射血分数的改善程度大于不完全血运重建组（绝对变化：11.0±11.9%对8.3±11.4%，交互作用P = .05）。
结论
在接受冠状动脉旁路移植术的缺血性心肌病患者中，完全血运重建与更好的长期结局以及更大程度的左心室功能恢复相关，应尽可能鼓励进行完全血运重建。
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