球囊肺动脉血管成形术和肺动脉内膜剥脱术后慢性血栓栓塞性肺动脉高压的治疗结果
Outcomes of Chronic Thromboembolic Pulmonary Hypertension After Balloon Pulmonary Angioplasty and Pulmonary Endarterectomy.
作者信息
Masaki Kohei, Hosokawa Kazuya, Funakoshi Kouta, Taniguchi Yu, Adachi Shiro, Inami Takumi, Yamashita Jun, Ogino Hitoshi, Tsujino Ichizo, Hatano Masaru, Yaoita Nobuhiro, Ikeda Nobutaka, Shimokawahara Hiroto, Tanabe Nobuhiro, Kubota Kayoko, Shigeta Ayako, Ogihara Yoshito, Horimoto Koshin, Dohi Yoshihiro, Kawakami Takashi, Tamura Yuichi, Tatsumi Koichiro, Abe Kohtaro
机构信息
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.
出版信息
JACC Asia. 2024 Jul 23;4(8):577-589. doi: 10.1016/j.jacasi.2024.05.007. eCollection 2024 Aug.
BACKGROUND
The contemporary outcome of balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are unclear.
OBJECTIVES
This study aimed to clarify the characteristics and outcomes of CTEPH patients treated with BPA and PEA in Japan.
METHODS
Among 1,270 participants enrolled between 2018 and 2023 in the CTEPH AC (Chronic Thromboembolic Pulmonary Hypertension Anticoagulant) registry, a Japanese nationwide CTEPH registry, 369 treatment-naive patients (BPA strategy: n = 313; PEA strategy: n = 56) and 690 on-treatment patients (BPA strategy: n = 561; PEA strategy: n = 129) were classified according to the presence of prior reperfusion therapy. Morbidity and mortality events (all-cause death, rescue mechanical reperfusion therapy, and/or initiation of parenteral pulmonary vasodilators), pulmonary hemodynamics, exercise tolerance, and relevant laboratory test results were evaluated.
RESULTS
The BPA strategy was chosen in older patients than the PEA strategy (mean age, BPA vs PEA: 66.5 ± 12.6 years vs 62.5 ± 11.8 years; = 0.028). Median follow-up period was 615 (Q1-Q3: 311-997) days in treatment-naive patients and 1,136 (Q1-Q3: 684-1,300) days in on-treatment patients. BPA strategy had as acceptable morbidity and mortality as PEA strategy (5-year morbidity and mortality event rate, BPA vs PEA: 10.2% [95% CI: 5.2%-19.5%] vs 16.1% [95% CI: 4.3%-50.6%] in treatment-naive patients; 9.7% [95% CI: 6.7%-13.8%] vs 6.9% [95% CI: 2.7%-17.3%] in on-treatment patients), with greater improvement of renal function; glomerular filtration rate in propensity score-matched population (difference between change: 4.9 [95% CI: 0.5-9.3] mL/min/1.73 m; = 0.030).
CONCLUSIONS
BPA strategy was more frequently chosen in older patients compared with PEA strategy and showed acceptable outcomes for efficacy with greater advantage for improvement in renal function. (Multicenter registry of chronic thromboembolic pulmonary hypertension in Japan; UMIN000033784).
背景
慢性血栓栓塞性肺动脉高压（CTEPH）患者接受球囊肺动脉血管成形术（BPA）和肺动脉内膜剥脱术（PEA）的当代疗效尚不清楚。
目的
本研究旨在阐明日本接受BPA和PEA治疗的CTEPH患者的特征和疗效。
方法
在日本全国性CTEPH注册研究CTEPH AC（慢性血栓栓塞性肺动脉高压抗凝）注册中心2018年至2023年纳入的1270名参与者中，根据是否接受过再灌注治疗，将369例初治患者（BPA策略组：n = 313；PEA策略组：n = 56）和690例正在接受治疗的患者（BPA策略组：n = 561；PEA策略组：n = 129）进行分类。评估发病率和死亡率事件（全因死亡、挽救性机械再灌注治疗和/或开始使用肠外肺血管扩张剂）、肺血流动力学、运动耐量和相关实验室检查结果。
结果
与PEA策略相比，BPA策略更多地用于老年患者（平均年龄，BPA组与PEA组：66.5±12.6岁 vs 62.5±11.8岁；P = 0.028）。初治患者的中位随访期为615（第一四分位数-第三四分位数：311-997）天，正在接受治疗的患者为1136（第一四分位数-第三四分位数：684-1300）天。BPA策略的发病率和死亡率与PEA策略相当（初治患者5年发病率和死亡率事件率，BPA组与PEA组：10.2%[95%置信区间：5.2%-19.5%] vs 16.1%[95%置信区间：4.3%-50.6%]；正在接受治疗的患者为9.7%[95%置信区间：6.7%-13.8%] vs 6.9%[95%置信区间：2.7%-17.3%]），且肾功能改善更明显；倾向评分匹配人群中的肾小球滤过率（变化差异：4.9[95%置信区间：0.5-9.3]mL/min/1.73m²；P = 0.030）。
结论
与PEA策略相比，老年患者更常选择BPA策略，其疗效可接受，在改善肾功能方面具有更大优势。（日本慢性血栓栓塞性肺动脉高压多中心注册研究；UMIN000033784）
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