脑梗塞后机械并发症手术治疗后的长期存活率:Caution 研究的结果。

IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Matteo Matteucci, Daniele Ronco, Mariusz Kowalewski, Giulio Massimi, Michele De Bonis, Francesco Formica, Federica Jiritano, Thierry Folliguet, Nikolaos Bonaros, Sandro Sponga, Piotr Suwalski, Andrea De Martino, Theodor Fischlein, Giovanni Troise, Guglielmo Actis Dato, Filiberto Giuseppe Serraino, Shabir Hussain Shah, Roberto Scrofani, Jurij Matija Kalisnik, Andrea Colli, Claudio Francesco Russo, Marco Ranucci, Matteo Pettinari, Adam Kowalowka, Matthias Thielmann, Bart Meyns, Fareed Khouqeer, Jean-Francois Obadia, Udo Boeken, Caterina Simon, Shiho Naito, Andrea Musazzi, Roberto Lorusso
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引用次数: 0

摘要

背景和目的:机械性并发症(MCs)是急性心肌梗死(AMI)罕见但可能致命的后遗症。手术虽然具有挑战性,但被认为是首选治疗方法。作者试图研究因急性心肌梗死后 MCs 而接受手术治疗的患者的早期和长期效果:方法:从 CAUTION 研究数据库中检索了 2001 年至 2019 年期间在全球 27 个中心接受手术治疗的脑梗死后 MCs 患者。院内死亡率和长期死亡率是主要结果。Cox比例危险回归模型用于确定与总死亡率相关的独立因素:研究共纳入 720 名患者。中位年龄为 70.0 [62.0-77.0] 岁,男性占多数(64.6%)。最常见的 MC 是室间隔破裂(VSR)(59.4%)。56.1%的患者在发病时出现心源性休克。院内死亡率为 37.4%;50% 以上病例的死因是低心排量综合征(LCOS)。133名患者在中位随访4.4[1.0-8.6]年后死亡。1年、5年和10年的总生存率分别为54.0%、48.1%和41.0%。年龄较大(P 结论:年龄越大,生存率越高:一项多中心队列研究的最新数据显示,AMI 后 MC 的手术治疗仍然与较高的院内死亡率相关。不过,术后即刻存活的患者的长期存活率令人鼓舞:NCT03848429.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term survival after surgical treatment for post-infarction mechanical complications: results from the Caution study.

Aims: Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study the early and long-term results of patients undergoing surgical treatment for post-AMI MCs.

Methods and results: Patients who underwent surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centres worldwide were retrieved from the database of the CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5, and 10 years was 54.0, 48.1, and 41.0%, respectively. Older age (P < 0.001) and post-operative LCOS (P < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significantly higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022).

Conclusion: Contemporary data from a multicentre cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate post-operative period is encouraging.

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来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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