缺血性心肌病冠状动脉搭桥术的异质性治疗效果：机器学习因果森林分析。

IF 4.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-11-01 DOI:10.1016/j.jtcvs.2023.09.021

Zhuoming Zhou MD , Bohao Jian MD , Xuanyu Chen PhD , Menghui Liu MD, PhD , Shaozhao Zhang MD , Guangguo Fu MD , Gang Li MD , Mengya Liang MD, PhD , Ting Tian PhD , Zhongkai Wu MD, PhD

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引用次数: 0

摘要

目的：我们旨在评估缺血性心肌病患者冠状动脉搭桥术的异质性治疗效果，并确定一组患者与单纯药物治疗相比，冠状动脉搭桥手术具有更大的益处。方法：采用机器学习因果森林模型，从缺血性心力衰竭的外科治疗试验中确定冠状动脉搭桥术对缺血性心肌病患者的异质性治疗效果。在已确定的亚组中评估了冠状动脉搭桥术和单独药物治疗之间任何原因死亡和心血管原因死亡的风险。结果：在1212名参加缺血性心力衰竭外科治疗试验的患者中，通过机器学习算法识别左心室收缩末期容积指数、血清肌酐和年龄，以区分具有不同治疗效果的患者。在左心室收缩末期容积指数大于84 mL/m2且年龄在60.27岁或以下的患者中，冠状动脉搭桥术与任何原因死亡的风险（调整后的危险比，0.61；95%可信区间，0.45-0.84）和心血管原因死亡的危险（调整后危险比，0.62；95%置信区间，0.45-2.89）显著降低相关。相比之下，冠状动脉旁路移植术的生存益处在左心室收缩末期容积指数为84mL/m2或更低且血清肌酐为1.04mg/dL或更低的患者中不再存在，或左心室收缩末期容积指数大于84 mL/m2且年龄大于60.27岁的患者。结论：目前对缺血性心力衰竭手术治疗试验的事后分析发现，冠状动脉搭桥术对缺血性心肌病患者的治疗效果参差不齐。患有严重左心室增大的年轻患者更有可能从冠状动脉搭桥术中获得更大的生存益处。

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Heterogeneous treatment effects of coronary artery bypass grafting in ischemic cardiomyopathy: A machine learning causal forest analysis

Objectives

We aim to evaluate the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy and to identify a group of patients to have greater benefits from coronary artery bypass grafting compared with medical therapy alone.

Methods

Machine learning causal forest modeling was performed to identify the heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy from the Surgical Treatment for Ischemic Heart Failure trial. The risks of death from any cause and death from cardiovascular causes between coronary artery bypass grafting and medical therapy alone were assessed in the identified subgroups.

Results

Among 1212 patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial, left ventricular end-systolic volume index, serum creatinine, and age were identified by the machine learning algorithm to distinguish patients with heterogeneous treatment effects. Among patients with left ventricular end-systolic volume index greater than 84 mL/m² and age 60.27 years or less, coronary artery bypass grafting was associated with a significantly lower risk of death from any cause (adjusted hazard ratio, 0.61; 95% CI, 0.45-0.84) and death from cardiovascular causes (adjusted hazard ratio, 0.63; 95% CI, 0.45-0.89). By contrast, the survival benefits of coronary artery bypass grafting no longer exist in patients with left ventricular end-systolic volume index 84 mL/m² or less and serum creatinine 1.04 mg/dL or less, or patients with left ventricular end-systolic volume index greater than 84 mL/m² and age more than 60.27 years.

Conclusions

The current post hoc analysis of the Surgical Treatment for Ischemic Heart Failure trial identified heterogeneous treatment effects of coronary artery bypass grafting in patients with ischemic cardiomyopathy. Younger patients with severe left ventricular enlargement were more likely to derive greater survival benefits from coronary artery bypass grafting.

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.