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【文摘发布】NEJM 抑肽酶对冠脉搭桥预后的影响
Andrew D. Shaw, M.B., Mark Stafford-Smith, M.D., William D. White, M.P.H., Barbara Phillips-Bute, Ph.D., Madhav Swaminathan, M.D., Carmelo Milano, M.D., Ian J. Welsby, M.B., Solomon Aronson, M.D., Joseph P. Mathew, M.D., Eric D. Peterson, M.D., M.P.H., and Mark F. Newman, M.D.
ABSTRACT
Background Aprotinin has recently been associated with adverse outcomes in patients undergoing cardiac surgery. We reviewed our experience with this agent in patients undergoing cardiac surgery at Duke University Medical Center.
Methods We retrieved data on 10,275 consecutive patients undergoing surgical coronary revascularization at Duke between January 1, 1996, and December 31, 2005. We fit data to a logistic-regression model predicting each patient's likelihood of receiving aprotinin on the basis of preoperative characteristics and to models predicting long-term survival (up to 10 years) and decline in renal function, as measured by increases in serum creatinine levels.
Results A total of 1343 patients (13.2%) received aprotinin, 6776 patients (66.8%) received aminocaproic acid, and 2029 patients (20.0%) received no antifibrinolytic therapy. All patients underwent coronary-artery bypass grafting, and 1181 patients (11.5%) underwent combined coronary-artery bypass grafting and valve surgery. In the risk-adjusted model, survival was worse among patients treated with aprotinin, with a main-effects hazard ratio for death of 1.32 (95% confidence interval [CI], 1.12 to 1.55) for the comparison with patients receiving no antifibrinolytic therapy (P=0.003) and 1.27 (95% CI, 1.10 to 1.46) for the comparison with patients receiving aminocaproic acid (P=0.004). As compared with the use of aminocaproic acid or no antifibrinolytic agent, aprotinin use was also associated with a larger risk-adjusted increase in the serum creatinine level (P<0.001) but not with a greater risk-adjusted incidence of dialysis (P=0.56).
Conclusions Patients who received aprotinin had a higher mortality rate and larger increases in serum creatinine levels than those who received aminocaproic acid or no antifibrinolytic agent. The Effect of Aprotinin on Outcome after Coronary-Artery Bypass Grafting
抑肽酶对冠脉搭桥预后的影响
ABSTRACT
摘要
Background Aprotinin has recently been associated with adverse outcomes in patients undergoing cardiac surgery. We reviewed our experience with this agent in patients undergoing cardiac surgery at Duke University Medical Center.
背景：最近有报道显示抑肽酶与接受心脏手术的患者不良预后相关。我们回顾了我们杜克大学医学中心接受心脏手术的患者应用这一药物的经验。
Methods We retrieved data on 10,275 consecutive patients undergoing surgical coronary revascularization at Duke between January 1, 1996, and December 31, 2005. We fit data to a logistic-regression model predicting each patient's likelihood of receiving aprotinin on the basis of preoperative characteristics and to models predicting long-term survival (up to 10 years) and decline in renal function, as measured by increases in serum creatinine levels.
方法：我们回顾了10275例于1996年1月1日至2005年12月31日在杜克大学接受外科冠脉再血管化的患者。我们采用logistic回归模型预测每一个患者在手术前因素的基础应用抑肽酶的可能性，并预测患者的长期生存（大于10年）和肾功能的恶化（以血肌酐水平升高衡量）。
Results A total of 1343 patients (13.2%) received aprotinin, 6776 patients (66.8%) received aminocaproic acid, and 2029 patients (20.0%) received no antifibrinolytic therapy. All patients underwent coronary-artery bypass grafting, and 1181 patients (11.5%) underwent combined coronary-artery bypass grafting and valve surgery. In the risk-adjusted model, survival was worse among patients treated with aprotinin, with a main-effects hazard ratio for death of 1.32 (95% confidence interval [CI], 1.12 to 1.55) for the comparison with patients receiving no antifibrinolytic therapy (P=0.003) and 1.27 (95% CI, 1.10 to 1.46) for the comparison with patients receiving aminocaproic acid (P=0.004). As compared with the use of aminocaproic acid or no antifibrinolytic agent, aprotinin use was also associated with a larger risk-adjusted increase in the serum creatinine level (P<0.001) but not with a greater risk-adjusted incidence of dialysis (P=0.56).
结果：1343例患者（13.2％）应用了抑肽酶，6776例患者（66.8％）接受了6-氨基已酸，2029例患者（20.0％）未接受抗纤维蛋白溶解治疗。所有的患者均接受了冠脉搭桥手术，其中1181例（11.5％）患者接受了冠脉搭桥术联合瓣膜手术。在危险因素校正模型中，接受抑肽酶治疗的患者有较差的生存率，与未接受抗纤维蛋白溶解治疗的患者相比对死亡的主要作用危险比为1.32（95% CI, 1.12 - 1.55）（P＝0.003）,与接受6-氨基已酸治疗的患者相比危险比为1.27(95% CI, 1.10 - 1.46)。与接受6-氨基已酸治疗以及未接受抗纤维蛋白溶解治疗相比，在校正了多种危险因素后接受抑肽酶治疗还与较大的血肌酐水平升高相关（P<0.001）但与透析增加无关（P＝0.56）。
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作者:admin@医学,生命科学 2011-05-05 17:49
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