JACC:糖尿病患者多支血管病变的长期存活率

2019-02-19 国际循环编辑部 国际循环

近日,JACC发表的一项研究评估在FREEDOM试验中接受冠状动脉血运重建的MVD患者的长期存活率。

FREEDOM试验(糖尿病患者未来血运重建的评价:多支血管病变的最佳治疗)已表明,糖尿病(DM)和多支冠状动脉病变(MVD)患者,冠状动脉旁路移植术(CABG)优于经皮冠状动脉置入药物洗脱支架(PCI-DES),降低主要不良血管和脑血管事件的发生率。中位随访3.8年。然而,目前,尚不清楚在延长随访期后患者行CABG是否有生存获益。近日,JACC发表的一项研究评估在FREEDOM试验中接受冠状动脉血运重建的MVD患者的长期存活率。



FREEDOM试验纳入1900例DM和MVD患者,随机分组,在最佳药物治疗的情况下接受西罗莫司洗脱或紫杉醇洗脱支架或CABG PCI。试验结束后,招募中心和患者被邀请参加FREEDOM后续研究。使用Kaplan-Meier分析评估存活率,并使用Cox比例风险模型进行亚组和多变量分析。

结果显示,共有25个中心同意参加FREEDOM随访研究,共有943例患者(占原队列的49.6%),中位随访时间为7.5年(范围0~13.2年)。在1900例患者中,有314例在整个随访期间死亡(原始试验中204例,FREEDOM后续研究随访中110例)。全因死亡率PCI-DES组高于CABG组[24.3%(159例死亡),18.3%(112例死亡),HR=1.36;95%CI:1.07~1.74;P=0.01]。其中,延长期随访943例,全因死亡率PCI-DES组23.7%(99例死亡)和CABG组18.7%(72例死亡)(HR=1.32;95%CI:0.97~1.78;P=0.076)。

上述研究结果表明,DM和MVD患者中,CABG组冠状动脉血运重建死亡率低于PCI-DES长期随访组。

原始出处:
Michael E. Farkouh, Michael Domanski, George D. Dangas,etal. Long-Term Survival Following Multivessel Revascularization in Patients With Diabetes. JACC. February 2019.

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    2019-08-21 hbwxf
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    2019-02-19 misszhang

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