目的:本研究旨在探讨指南指导药物治疗(GDMT)对慢性威胁肢体缺血(CLTI)患者血运重建后10年死亡率的长期影响。
方法:我们进行了一项回顾性多中心研究,纳入了2007年1月至2011年12月间接受血运重建的459例CLTI患者(396例血管内治疗[EVT]和63例搭桥手术[BSX])。主要结局指标是全因死亡率。我们还使用Cox回归风险模型探索了全因死亡率的预测因素;GDMT的影响,定义为抗血小板药的处方,他汀类药物,和血管紧张素转换酶(ACE)抑制剂或血管紧张素受体阻滞剂(ARB),关于全因死亡率,以及使用交互效应的基线特征之间的关联。
结果:在血运重建后的10年随访中,234名患者死亡。在Kaplan-Meier分析中,接受他汀类药物(p<.001)和ACE抑制剂或ARB(p=.010)的患者的10年死亡率明显低于未接受他汀类药物的患者。然而,接受抗血小板药物治疗的患者和未接受抗血小板药物治疗的患者的10年死亡率无差异(p=.62).相互作用分析显示,GDMT在接受和未接受血液透析的患者以及接受EVT或BSX治疗的患者中具有显着不同的风险比(相互作用的p分别为.002和.044)。在多变量分析中,年龄>75岁,非活动状态,血液透析,充血性心力衰竭,左心室射血分数<50%,GDMT和GDMT与全因死亡率显著相关.
结论:适当使用GDMT与CLTI患者血运重建后10年死亡率独立相关。
OBJECTIVE: This study aimed to investigate the long-term impact of
guideline-directed medical therapy (GDMT) on 10-year mortality in patients with chronic limb-threatening ischaemia (CLTI) after revascularization.
METHODS: We performed a retrospective multicentre study enrolle 459 patients with CLTI who underwent revascularization (396 endovascular therapy [EVT] and 63 bypass surgery [BSX] cases) between January 2007 and December 2011. The primary outcome measure was all-cause mortality. We additionally explored the predictors for all-cause mortality using Cox regression hazard models; the influence of GDMT, defined as prescription of antiplatelet agents, statins, and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in aggregate, on all-cause mortality, and the association between baseline characteristics using interaction effects.
RESULTS: During the 10-year follow-up after revascularization, 234 patients died. In Kaplan-Meier analysis, 10-year mortality was significantly lower in patients who received statins (p<.001) and ACE inhibitors or ARBs (p=.010) than those who did not. However, there were no differences in 10-year mortality between patients who received anti-platelet agents and those who did not (p=.62). Interaction analysis revealed that GDMT had a significantly different hazard ratio in patients who were and were not on hemodialysis and in those treated with EVT or BSX (p for interaction =.002 and .044, respectively). In the multivariate analysis, age >75 years, non-ambulatory status, hemodialysis, congestive heart failure, left ventricular ejection fraction <50%, and GDMT were significantly associated with all-cause mortality.
CONCLUSIONS: Appropriate GDMT use was independently associated with 10-year mortality in patients with CLTI after revascularization.