冠状动脉旁路移植术后二级预防的预后影响——来自 TiCAB 试验的见解,European Journal of Cardio-Thoracic Surgery

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冠状动脉旁路移植术后二级预防的预后影响——来自 TiCAB 试验的见解
European Journal of Cardio-Thoracic Surgery ( IF 3.1 ) Pub Date : 2022-01-31 , DOI: 10.1093/ejcts/ezac048
Tobias Heer ₁ , Moritz von Scheidt _{2,

3} , Andreas Boening ₄ , Clarissa Heyken ₂ , Friederike Gusmini ₂ , Antoinette de Waha ₂ , Constantin Kuna ₂ , Andreas Fach ₅ , Christina Grothusen ₆ , Martin Oberhoffer ₇ , Christoph Knosalla _{8,

9} , Thomas Walther ₁₀ , Bernhard C Danner ₁₁ , Martin Misfeld ₁₂ , Gerhard Wimmer-Greinecker ₁₃ , Matthias Siepe ₁₄ , Herko Grubitzsch ₁₅ , Alexander Joost ₁₆ , Andreas Schaefer ₁₇ , Lenard Conradi ₁₇ , Jochen Cremer ₆ , Christian Hamm _{18,

19} , Rüdiger Lange ₂₀ , Peter W Radke ₂₁ , Rainer Schulz ₂₂ , Günther Laufer ₂₃ , Philippe Grieshaber ₂₄ , Tim Attmann ₆ , Michael Schmoeckel ₂₅ , Alexander Meyer _{8,

9} , Tibor Ziegelhöffer ₂₆ , Rainer Hambrecht ₅ , Sigrid E Sandner ₂₃ , Adnan Kastrati _{2,

3} , Heribert Schunkert _{2,

3} , Uwe Zeymer ₂₇

Affiliation

Department of Cardiology, München Klinik Neuperlach, Munich, Germany.
Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany.
Department of Cardiology and Angiology, Klinikum Links der Weser, Bremen, Germany.
Department of Cardiac Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
Department of Cardiac Surgery, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Department of Cardiac Surgery, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany.
Department of Thoracic and Cardiovascular Surgery, University Medical Center, Göttingen, Germany.
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen, Germany.
Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany.
Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine, Medical Clinic II, University Hospital Schleswig-Holstein, Lübeck, Germany.
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Department of Cardiology, Justus-Liebig University Gießen, Kerckhoff Campus, Gießen, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Rhein-Main, Rhein-Main, Germany.
Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Department of Internal Medicine-Cardiology, Schön Klinik Neustadt SE & Co. KG, Neustadt, Germany.
Institute of Physiology, Justus-Liebig University Gießen, Gießen, Germany.
Division of Cardiac Surgery, Medical University Vienna, Wien, Austria.
Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.

目的冠状动脉旁路移植术 (CABG) 后对指南推荐治疗的依从性存在差异。因此，我们试图评估遵循指南的医学二级预防对 CABG 后 1 年结果的影响。方法数据取自随机“CABG 中的替格瑞洛”试验。从 2013 年 4 月到 2017 年 4 月，接受了 CABG 的患者被纳入。对于目前的分析，我们将接受最佳医学二级预防治疗的患者与缺少一种或多种推荐药物的患者进行比较。结果 1807 名患者获得了 12 个月的随访数据。其中约一半（54%）接受了最佳二级预防治疗。全因死亡率 [0.5% vs 3.5%, 风险比 (HR) 0.14 (0.05–0.37), P < 0.01]，心血管死亡率 [0.1% vs 1.7%，HR 0。06 (0.01–0.46), P = 0.007] 和主要不良事件 [6.5% vs 11.5%, HR 0.54 (0.39–0.74), P <; 0.01]在具有最佳二级预防的组中显着降低。基于与指南推荐治疗的二元一致性的主要终点多变量模型确定了 3 个独立因素：对指南推荐治疗的依从性 [HR 0.55 (0.39–0.78)，P <; 0.001]; 肾功能正常 [HR 0.99 (0.98–0.99), P = 0.040]；和非体外循环手术 [HR 2.06 (1.02–4.18), P = 0.045]。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。01]在具有最佳二级预防的组中显着降低。基于与指南推荐治疗的二元一致性的主要终点多变量模型确定了 3 个独立因素：对指南推荐治疗的依从性 [HR 0.55 (0.39–0.78)，P <; 0.001]; 肾功能正常 [HR 0.99 (0.98–0.99), P = 0.040]；和非体外循环手术 [HR 2.06 (1.02–4.18), P = 0.045]。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。01]在具有最佳二级预防的组中显着降低。基于与指南推荐治疗的二元一致性的主要终点多变量模型确定了 3 个独立因素：对指南推荐治疗的依从性 [HR 0.55 (0.39–0.78)，P <; 0.001]; 肾功能正常 [HR 0.99 (0.98–0.99), P = 0.040]；和非体外循环手术 [HR 2.06 (1.02–4.18), P = 0.045]。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。基于与指南推荐治疗的二元一致性的主要终点多变量模型确定了 3 个独立因素：对指南推荐治疗的依从性 [HR 0.55 (0.39–0.78)，P <; 0.001]; 肾功能正常 [HR 0.99 (0.98–0.99), P = 0.040]；和非体外循环手术 [HR 2.06 (1.02–4.18), P = 0.045]。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。基于与指南推荐治疗的二元一致性的主要终点多变量模型确定了 3 个独立因素：对指南推荐治疗的依从性 [HR 0.55 (0.39–0.78)，P <; 0.001]; 肾功能正常 [HR 0.99 (0.98–0.99), P = 0.040]；和非体外循环手术 [HR 2.06 (1.02–4.18), P = 0.045]。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。结论只有每 2 名患者在 CABG 后接受最佳二级预防。遵循指南的二级预防治疗与较低的中期死亡率和 12 个月后的不良心血管事件相关。

"点击查看英文标题和摘要"

Prognostic impact of secondary prevention after coronary artery bypass grafting—insights from the TiCAB trial

OBJECTIVES There are disparities in the adherence to guideline-recommended therapies after coronary artery bypass graft (CABG). We therefore sought to evaluate the effect of guideline-adherent medical secondary prevention on 1-year outcome after CABG. METHODS Data were taken from the randomized ‘Ticagrelor in CABG’ trial. From April 2013 until April 2017, patients who underwent CABG were included. For the present analysis, we compared patients who were treated with optimal medical secondary prevention with those where 1 or more of the recommended medications were missing. RESULTS Follow-up data at 12 months were available in 1807 patients. About half (54%) of them were treated with optimal secondary prevention. All-cause mortality [0.5% vs 3.5%, hazard ratio (HR) 0.14 (0.05–0.37), P < 0.01], cardiovascular mortality [0.1% vs 1.7%, HR 0.06 (0.01–0.46), P = 0.007] and major adverse events [6.5% vs 11.5%, HR 0.54 (0.39–0.74), P < 0.01] were significantly lower in the group with optimal secondary prevention. The multivariable model for the primary end point based on binary concordance to guideline recommended therapy identified 3 independent factors: adherence to guideline recommended therapy [HR 0.55 (0.39–0.78), P < 0.001]; normal renal function [HR 0.99 (0.98–0.99), P = 0.040]; and off-pump surgery [HR 2.06 (1.02–4.18), P = 0.045]. CONCLUSIONS Only every second patient receives optimal secondary prevention after CABG. Guideline adherent secondary prevention therapy is associated with lower mid-term mortality and less adverse cardiovascular events after 12 months.

更新日期：2022-01-31

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