PDF(Pubmed)
Abstract：
UNASSIGNED: Whether the association between post-therapeutic left ventricular volume change and long-term outcomes in ischaemic cardiomyopathy is influenced by the performance of coronary artery bypass grafting (CABG) remains unclear. We sought to perform a post-hoc analysis of the Surgical Treatment of Ischaemic Heart Failure (STICH) trial to investigate this association in patients treated with medical therapy (MED) with or without CABG.
UNASSIGNED: From July 24, 2002, to May 5, 2007, 1212 patients with ischaemic cardiomyopathy were enrolled in the STICH trial (NCT00023595) from 99 sites in 22 countries, and were randomly assigned to undergo CABG plus MED or MED alone. We completed a post-hoc analysis of this trial. Patients with paired left ventricular end-systolic volume index (ESVI) measured at baseline and 4-months were included in our analysis. The association between change in ESVI from baseline to 4-months and cardiovascular mortality or all-cause mortality was assessed in MED arm and CABG plus MED arm.
UNASSIGNED: 523 patients were included, with 291 (55.6%) assigned to MED arm and 232 (44.4%) to CABG plus MED arm. At a 4-month follow-up, ESVI reduction was more likely to occur among patients undergoing CABG plus MED. After a median follow-up of 10.3 years, for each 26% (1- standard deviation) decrement in ESVI, it was associated with a 22% lower risk of cardiovascular mortality (HR 0.78; 95% CI, 0.65-0.94) and 19% lower risk of all-cause mortality (HR 0.81; 95% CI, 0.69-0.95) in MED arm, whereas this association was not shown in CABG plus MED arm (cardiovascular mortality: HR 0.90; 95%CI, 0.74-1.10; all-cause mortality: HR 0.93; 95%CI, 0.79-1.09). A 16% reduction in ESVI was determined to be the most appropriate threshold of change in ESVI in the MED arm.
UNASSIGNED: In patients with ischaemic cardiomyopathy, left ventricular volume change was associated with long-term prognosis after medical therapy alone, whereas was likely not an optimal benchmark for evaluating the survival benefits associated with CABG. A more than 16% reduction in ESVI might assist in therapeutic efficacy assessment and prognostic evaluation in medically treated patients.
UNASSIGNED: National Natural Science Foundation of China; Natural Science Funds of Guangdong Province.
UNASSIGNED: From July 24, 2002, to May 5, 2007, 1212 patients with ischaemic cardiomyopathy were enrolled in the STICH trial (NCT00023595) from 99 sites in 22 countries, and were randomly assigned to undergo CABG plus MED or MED alone. We completed a post-hoc analysis of this trial. Patients with paired left ventricular end-systolic volume index (ESVI) measured at baseline and 4-months were included in our analysis. The association between change in ESVI from baseline to 4-months and cardiovascular mortality or all-cause mortality was assessed in MED arm and CABG plus MED arm.
UNASSIGNED: 523 patients were included, with 291 (55.6%) assigned to MED arm and 232 (44.4%) to CABG plus MED arm. At a 4-month follow-up, ESVI reduction was more likely to occur among patients undergoing CABG plus MED. After a median follow-up of 10.3 years, for each 26% (1- standard deviation) decrement in ESVI, it was associated with a 22% lower risk of cardiovascular mortality (HR 0.78; 95% CI, 0.65-0.94) and 19% lower risk of all-cause mortality (HR 0.81; 95% CI, 0.69-0.95) in MED arm, whereas this association was not shown in CABG plus MED arm (cardiovascular mortality: HR 0.90; 95%CI, 0.74-1.10; all-cause mortality: HR 0.93; 95%CI, 0.79-1.09). A 16% reduction in ESVI was determined to be the most appropriate threshold of change in ESVI in the MED arm.
UNASSIGNED: In patients with ischaemic cardiomyopathy, left ventricular volume change was associated with long-term prognosis after medical therapy alone, whereas was likely not an optimal benchmark for evaluating the survival benefits associated with CABG. A more than 16% reduction in ESVI might assist in therapeutic efficacy assessment and prognostic evaluation in medically treated patients.
UNASSIGNED: National Natural Science Foundation of China; Natural Science Funds of Guangdong Province.
摘要：
UNASSIGNED：缺血性心肌病治疗后左心室容积变化与长期预后之间的关联是否受冠状动脉旁路移植术(CABG)的影响尚不清楚。我们试图对缺血性心力衰竭的外科治疗（STICH）试验进行事后分析，以研究接受药物治疗（MED）且有或没有CABG的患者的这种关联。
UNASSIGNED：从2002年7月24日至2007年5月5日，来自22个国家的99个研究中心的1212例缺血性心肌病患者被纳入STICH试验（NCT00023595），并被随机分配接受CABG+MED或单独接受MED。我们完成了对该试验的事后分析。我们的分析包括在基线和4个月测量的配对左心室收缩末期容积指数（ESVI）的患者。在MED组和CABG+MED组中评估了ESVI从基线到4个月的变化与心血管死亡率或全因死亡率之间的关系。
未经批准：纳入523例患者，291(55.6%)分配给MED组，232(44.4%)分配给CABG+MED组。在4个月的随访中，在接受CABG加MED的患者中，ESVI降低的可能性更大。在中位随访10.3年后，ESVI每减少26%(1-标准偏差)，在MED组，它与心血管死亡率风险降低22％（HR0.78;95％CI，0.65-0.94）和全因死亡率风险降低19％（HR0.81;95％CI，0.69-0.95）相关，而CABG+MED组(心血管死亡率:HR0.90;95CI,0.74~1.10;全因死亡率:HR0.93;95CI,0.79~1.09)未显示这种关联.ESVI降低16%被确定为MED臂中ESVI变化的最合适阈值。
未经证实：缺血性心肌病患者，左心室容积改变与单纯药物治疗后的长期预后相关,然而，这可能不是评估与CABG相关的生存获益的最佳基准。ESVI降低16％以上可能有助于药物治疗患者的疗效评估和预后评估。
UNASSIGNED:国家自然科学基金;广东省自然科学基金.
UNASSIGNED：从2002年7月24日至2007年5月5日，来自22个国家的99个研究中心的1212例缺血性心肌病患者被纳入STICH试验（NCT00023595），并被随机分配接受CABG+MED或单独接受MED。我们完成了对该试验的事后分析。我们的分析包括在基线和4个月测量的配对左心室收缩末期容积指数（ESVI）的患者。在MED组和CABG+MED组中评估了ESVI从基线到4个月的变化与心血管死亡率或全因死亡率之间的关系。
未经批准：纳入523例患者，291(55.6%)分配给MED组，232(44.4%)分配给CABG+MED组。在4个月的随访中，在接受CABG加MED的患者中，ESVI降低的可能性更大。在中位随访10.3年后，ESVI每减少26%(1-标准偏差)，在MED组，它与心血管死亡率风险降低22％（HR0.78;95％CI，0.65-0.94）和全因死亡率风险降低19％（HR0.81;95％CI，0.69-0.95）相关，而CABG+MED组(心血管死亡率:HR0.90;95CI,0.74~1.10;全因死亡率:HR0.93;95CI,0.79~1.09)未显示这种关联.ESVI降低16%被确定为MED臂中ESVI变化的最合适阈值。
未经证实：缺血性心肌病患者，左心室容积改变与单纯药物治疗后的长期预后相关,然而，这可能不是评估与CABG相关的生存获益的最佳基准。ESVI降低16％以上可能有助于药物治疗患者的疗效评估和预后评估。
UNASSIGNED:国家自然科学基金;广东省自然科学基金.
