冠状动脉搭桥手术改善缺血性心肌病患者有限的平均生存时间

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice Pub Date : 2025-04-04 DOI:10.1016/j.ahjo.2025.100538

Samuel W. Reinhardt, Haocheng Huang, Helen Parise, Tariq Ahmad, Eric J. Velazquez, Kamil F. Faridi

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引用次数: 0

摘要

临床试验通常使用Cox比例风险模型，该模型在评估程序性干预措施时可能不准确。限制平均生存时间（RMST）是一种可替代的结果测量方法，可在不假设成比例风险的情况下量化治疗效果。方法：我们根据RMST确定缺血性心衰手术治疗（STICH）试验的结果，这是一项国际多中心随机临床试验，比较冠状动脉搭桥术（CABG）联合最佳药物治疗与单独最佳药物治疗对缺血性心肌病患者的影响。结果：对于全因死亡率的主要终点，在使用RMST测量的10年随访中，CABG加药物治疗优于单独药物治疗。在评估全因死亡率的亚组分析中，与白人患者相比，少数种族/民族的CABG有更大的有益效果。结论：这些发现强化了冠脉搭桥的益处，并可用于量化缺血性心肌病患者的预期预后。

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Coronary artery bypass surgery improves restricted mean survival time in patients with ischemic cardiomyopathy

Introduction

Clinical trials commonly use Cox proportional hazards models, which may be inaccurate when evaluating procedural interventions. Restricted mean survival time (RMST) is an alternative outcome measure that quantifies treatment effects without assuming proportional hazards.

Methods

We determined outcomes based on RMST in the Surgical Treatment for Ischemic Heart Failure (STICH) trial, an international multicenter randomized clinical trial comparing coronary artery bypass grafting (CABG) plus optimal medical therapy to optimal medical therapy alone in patients with ischemic cardiomyopathy.

Results

For the primary endpoint of all-cause mortality, CABG plus medical therapy was superior to medical therapy alone at 10 years of follow up when using measures of RMST. In subgroup analyses evaluating all-cause mortality, there was a greater beneficial effect of CABG for racial/ethnic minorities vs. white patients.