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不停跳或停跳冠状动脉旁路移植术后的5年结局研究
Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting


André Lamy ... 心脑血管疾病 • 2016.12.15

特别关注停跳或不停跳冠脉旁路移植术后5年的

 

何国伟

中国医学科学院/北京协和医学院泰达国际心血管病医院

 

近20多年来,对停跳或不停跳冠脉旁路移植术的指征及近远期效果的评价一直是未完全明确的重要临床问题。由于循证医学的证据不足,对需要做冠脉旁路移植术的患者采取停跳或不停跳方式,在相当大的程度上取决于医院的条件及主刀医师的带有一定主观偏向的决策。这在中国可能比在欧美国家更为明显,以至于在相当长的一段时间内,在中国的若干医院内,不停跳冠脉旁路移植术的比例明显高于国外。在经历了20多年的争议后,我们应该对这一重要临床问题做出基于循证医学的结论了。

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摘要


背景

我们以前报道过在接受心脏不停跳(非停跳)冠状动脉旁路移植(CABG)的患者与接受心脏停跳(停跳)CABG的患者之间,30天或1年时由死亡、卒中、心肌梗死或肾衰竭组成的复合结局发生率无显著差异。现在,我们报道5年时(试验结束)的结果。

 

方法

共4,752例(来自19个国家)冠心病患者被随机分配到非停跳CABG组或停跳CABG组。我们在本报道中分析了死亡、卒中、心肌梗死、肾衰竭或重复冠脉血运重建(CABG或经皮冠脉介入治疗)的复合结局。平均随访时间是4.8年。

 

结果

非停跳CABG组和停跳CABG组间复合结局发生率(分别是23.1%和23.6%;非停跳组风险比,0.98;95%可信区间[CI],0.87~1.10;P=0.72),或包括重复血运重建(非停跳组是2.8%,停跳组是2.3%;停跳组的风险比,1.21;95% CI,0.85~1.73;P=0.29)在内的结局的组分发生率,没有显著差异。整个试验期的次要结局——每位患者的平均花费(美元),在非停跳组和停跳组间也无显著差异(分别是$15,107和$14,992;组间差异,$115;95% CI,-$697至$927)。生活质量指标无显著的组间差异。

 

结论

本试验中,在随访5年时的死亡、卒中、心肌梗死、肾衰竭,或重复血运重建的复合结局发生率在接受非停跳CABG的患者和停跳CABG的患者间相似(加拿大健康研究院[Canadian Institutes of Health Research]资助;CORONARY在ClinicalTrials.gov注册号为NCT00463294)。





作者信息

André Lamy, M.D., P.J. Devereaux, M.D., Ph.D., Dorairaj Prabhakaran, M.D., David P. Taggart, Ph.D., Shengshou Hu, M.D., Zbynek Straka, M.D., Leopoldo S. Piegas, M.D., Alvaro Avezum, M.D., Ahmet R. Akar, M.D., Fernando Lanas Zanetti, M.D., Anil R. Jain, M.D., Nicolas Noiseux, M.D., Chandrasekar Padmanabhan, M.D., Juan-Carlos Bahamondes, M.D., Richard J. Novick, M.D., Liang Tao, M.D., Pablo A. Olavegogeascoechea, M.D., Balram Airan, M.D., Toomas-Andres Sulling, M.D., Richard P. Whitlock, M.D., Yongning Ou, M.Sc., Peggy Gao, M.Sc., Shirley Pettit, R.N., and Salim Yusuf, D.Phil., for the CORONARY Investigators*
Address reprint requests to Dr. Lamy at the Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada, or at lamya@mcmaster.ca. *A complete list of investigators in the CABG Off or On Pump Revascularization Study (CORONARY) is provided in the Supplementary Appendix, available at NEJM.org.

 

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