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10年时双侧与单侧胸廓内动脉桥血管的比较
Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years


David P. Taggart ... 心脑血管疾病 • 2019.01.31
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敢问在何方——评判CABG动脉桥使用的ART10年结果发表

 

朱云鹏,朱嘉希,赵强*

上海交通大学医学院附属瑞金医院心脏中心和心脏外科

*通讯作者

 

历时10年随访,旨在比较在冠状动脉旁路移植术(CABG)中,使用双侧还是单侧胸廓内动脉桥血管效果更好的ART(Arterial Revascularization Trial)试验结果终于发表于2019年1月31日的《新英格兰医学杂志》(NEJM)。

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摘要


背景

冠状动脉旁路移植术(CABG)后,与单根动脉桥血管相比,多根动脉桥血管可能获得较长的生存期。我们评估了使用双侧胸廓内动脉桥血管进行的CABG。

 

方法

我们将计划接受CABG的患者随机分组,分别接受双侧或单侧胸廓内动脉移植术。根据适应证使用了另外的动脉或静脉桥血管。主要结局为10年时的全因死亡。次要结局为由全因死亡、心肌梗死或卒中构成的复合终点。

 

结果

共有1,548例患者被随机分配接受双侧胸廓内动脉移植(双侧移植组),1,554例患者被随机分配接受单侧胸廓内动脉移植(单侧移植组)。在双侧移植组中,13.9%的患者仅接受了单侧胸廓内动脉移植,在单侧移植组中,21.8%的患者还接受了桡动脉移植。10年时,2.3%患者的生存状态未知。在10年时进行的意向治疗分析中,双侧移植组和单侧移植组分别有315例(20.3%的患者)和329例(21.2%)患者死亡(风险比,0.96;95%置信区间[CI],0.82~1.12;P=0.62)。对于由死亡、心肌梗死或卒中构成的复合结局,双侧移植组和单侧移植组分别有385例(24.9%)和425例患者(27.3%)发生事件(风险比,0.90;95% CI,0.79~1.03)。

 

结论

在意向治疗分析中,在计划接受CABG并且被随机分配接受双侧或单侧胸廓内动脉移植的患者中,10年时的全因死亡率无显著组间差异。我们需要通过进一步研究确定与单根胸廓内动脉桥血管相比,多根动脉桥血管是否使患者获得较好的结局(由英国健康基金会[British Heath Foundation]等资助;在Current Controlled Trials注册号为ISRCTN46552265)。





作者信息

David P. Taggart, M.D., Ph.D., Umberto Benedetto, M.D., Ph.D., Stephen Gerry, M.Sc., Douglas G. Altman, D.Sc., Alastair M. Gray, Ph.D., Belinda Lees, Ph.D., Mario Gaudino, M.D., Vipin Zamvar, M.S., F.R.C.S., Andrzej Bochenek, M.D., Brian Buxton, M.D., Cliff Choong, M.D., Stephen Clark, M.D., Marek Deja, M.D., Jatin Desai, M.D., Ragheb Hasan, M.D., Marek Jasinski, M.D., Peter O’Keefe, M.D., Fernando Moraes, M.D., John Pepper, M.D., Siven Seevanayagam, M.D., Catherine Sudarshan, M.D., Uday Trivedi, M.D., Stanislaw Wos, M.D., John Puskas, M.D., and Marcus Flather, M.B., B.S. for the Arterial Revascularization Trial Investigators†
From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King’s College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) — all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke’s (J. Puskas) — both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) — all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.). Address reprint requests to Dr. Flather at Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom, or at m.flather@uea.ac.uk. Douglas G. Altman, D.Sc., is deceased. †A complete list of the investigators in the Arterial Revascularization Trial is provided in the Supplementary Appendix, available at NEJM.org.

 

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