Kòmantè: Maladi ren kwonik ak operasyon bypass kowonè: fè li dwat

Pou plis enfòmasyon. kontaktedavid.wan@wecistanche.com

MESAJ SANTRAL: Maladi ren kwonik ki twò grav pou modere pa sanble enfliyanse benefis siviv alontèm operasyon bypass kowonè.

Klike sou sit sa a pou w aprann plis sou Cistanche

Se chirijyen ki gen responsablite pou yo bay tretman oswa operasyon ki kòrèk la, ki vize pou chak pasyan endividyèl. Nan kontèks operasyon grèf kowonè (CABG), prèv ki montre yon avantaj siviv pou pasyan ki gen maladi atè kowonè konplèks ap grandi, patikilyèman nan gwoup espesifik tankou moun ki gen dyabèt. Maladi ren kwonik (CKD) se souvan nan pasyan ki gen ateroskleroz ak / oswa dyabèt ki prezante ak maladi atè kowonè epi li se yon faktè risk li te ye pou CABG. Li pa klè si ogmante risk perioperativ sa a limite efè tretman CABG.

Doesn't and colleagues°assess the influence of CKD on 10-year mortality and cardiovascular(CV) outcomes in patients with ischemic heart failure. They undertook a secondary analysis of data from the Surgical Treatment for Ischemic Heart Failure(STICH) trial, which randomized systolic heart failure patients to CABG and medical therapy versus medical therapy alone, and showed a survival advantage for patients also having CABG. Baseline estimated glomerular filtration rates(eGFRs)were calculated and the 1209 patients, randomized to medical therapy or CABG in the STICH trial, were categorized as CKD stages 1 through 5.Stage 1:eGFR>90 mL/min (n=232), etap 2: eGFR60 a 89 mL/min (n=646), etap 3: eGFR 30 a 59 mL/min (n=303) ak etap 4 ak 5: eGFR<30 ml/min(n="28)." baseline="" characteristics="" of="" patients="" in="" the="" 2="" treatment="" arms="" were="" equal="" for="" each="" ckd="" stage.="" however,="" patients="" in="" ckd="" stages="" 3="" through="" 5="" were="" older="" than="" those="" in="" stages="" 1="" and="" 2(aged="" 66-71="" vs="" 54-59="" years)="" and="" had="" more="" comorbidities.="" there="" was="" an="" inverse="" association="" linear="" relationship="" between="" egfr="" and="" risk="" of="" death,="" cv="" death,="" and/or="" cv="" rehospitalization="" (all="" p="" values="" <="" .001).="" the="" study's="" primary="" outcome="" showed="" a="" significant="" improvement="" in="" 10-year="" survival="" and="" cv="" rehospitalization="" rates="" by="" cabg="" in="" ckd="" stages="" 1="" through="" 3.="" these="" data="" were="" inconclusive="" in="" ckd="" stages="" 4="" and="" 5,="" probably="" due="" to="" the="" small="" sample="">

Gen prèv limite, sitou ki baze sou analiz baz done retrospektiv, sou si wi ou non CKD afekte benefis nan tretman nan CABG., Malgre ke sa a se yon analiz segondè nan esè STICH la, Doenst ak kòlèg yo demontre, pou premye fwa lè l sèvi avèk done ki sòti nan yon etid potansyèl randomized. , ke CKD modere-a-modere pa parèt enfliyanse benefis alontèm nan CABG. Gen limit enpòtan, tankou kantite pasyan limite nan etap CKD ki pi wo ak pi ba yo. Anplis de sa, paske esè STICH la pa te mache pou tès entèraksyon, konfizyon rezidyèl pa ka vrèman eskli. Finalman, nenpòt konklizyon aplike nan CKD modere-modere sèlman epi yo se nan pasyan ki gen ensifizans kadyak ak fraksyon redwi ekspilsyon.

Nan pratik lavi reyèl, prezans CKD ka yon predikatè pou pa refere pasyan yo pou operasyon.0 Malgre ke rezilta etid la pa Doenst ak kòlèg yo ka konteste," gen plis enfòmasyon yo mande anvan yon rekòmandasyon. pou tretman CABG ka fèt nan tout pasyan CKD otreman-apwopriye.Efè sa yo ta dwe konfime kèlkeswa fraksyon vantrikulè gòch ak pou pasyan ki gen klas ki pi grav nan CKD ki gen pi piti chans yo dwe refere pou operasyon.Anplis de sa, koupe -ponp operasyon ak nouvo mezi pharmaceutique ki ka plis amelyore benefis ki genyen nan CABG nan pasyan ki gen CKD yo pral mande pou envestigasyon.Men, Doenst ak kòlèg degre bay plis UN nan enpòtans ki genyen nan etabli tretman ki kòrèk la pou pasyan an dwa.

Referans

1. Head SJ,Milojevic M,Daemen J,Ahn JM,Boersma E,Christiansen EH,et al.

Mòtalite apre grèf kontoune atè kowonè kont entèvansyon kowonè perkutane ak stenting pou maladi atè kowonè: yon analiz rezime done pasyan endividyèl yo. Lancet.2018;391:939-48.

2. Sipahi I,Akay MH,Dagdelen S,Blitz A,Alhan C.Koronè atè bypass grèf-

ing vs perkutane entèvansyon kowonè ak mòtalite alontèm ak morbidite nan maladi multivessel: yon meta-analiz nan esè klinik owaza nan epòk grèf atè ak stenting. JAMA Intern Med.2014;174:223-30.

3. Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, et al.

Estrateji pou revascularization multivessel nan pasyan ki gen dyabèt. N Engl J Med.2012;367:2375-84.

4. Doenst T, Wijeysundera D,Karkouti K,Zechner C,Maganti M,Rao V,et al.Hy-

ipèglisemi pandan bypass kadyopulmonè se yon faktè risk endepandan pou mòtalite nan pasyan ki sibi operasyon kadyak. J Thorac Cardiovasc Surg. 2005;130:1144.

5. Ranucci M, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G.Risk nan as-

sessing risk mòtalite nan operasyon kadyak ochwa: laj, kreyatinin, fraksyon ekspilsyon, ak lwa a nan parsimoni. Circulation.2009;119:3053-61.

6. Doenst T, Haddad H, Stebbins A, Hill JA, Velazquez JE, Lee KL, et al. Ren

fonksyon ak operasyon bypass kowonè nan pasyan ki gen ensifizans kadyak ischemik. J Thorac Cardiovasc Surg.2022;163:664-72.e3.

7.VelazquezEJ, Lee KL, Jones RH, Al-Khalidi HR, HillJA,Panza JA,et al.Cor-

operasyon bypass kowonè-atè nan pasyan ki gen kardyopati ischemik. N Engl J Med.2016;374:1511-20.

8. Bangalore S, Guo Y, SamadashviliZ, Blecker S, Xu J, Hannan EL.Everolimus-

eluting stents oswa operasyon bypass pou maladi kardyovaskulèr multivessel.N Engl J Med. 2015;372:1213-22.

9. Roberts JK, Rao SV, Shaw LK, Gallup DS, Marroquin OC, Patel UD.Compare-

efikasite aktif nan pwosedi revaskularizasyon kowonè pou maladi atè kowonè multivessel nan pasyan ki gen maladi ren kwonik. Am J Cardiol.2017;119:1344-51.

10.Ram E, Goldenberg I, Kassif Y, Segev A, Lavee J, Einhorn-Cohen M, et al.

Karakteristik lavi reyèl ak rezilta pasyan ki sibi entèvansyon perkutane kowonè kont grèf kontoune atè kowonè pou maladi atè kowonè prensipal gòch: done ki sòti nan potansyèl Multi-veso Maladi kowonè (MULTI CARD)Israeli Registry.Eur J Cardiothorac Surg.2018;54 :717-23.

11. Demirijian S,Ailawadi G.Polinsky M,Bitran D.Silberman S,

Shernan SK, et al. Etid sekirite ak tolerans nan yon ti operasyon kadyotoracik entèferans asid ribonukleik (siRNA) ki te administre nan venn nan pasyan ki riske aksidan nan ren egi. Kidney Int Rep.2017;2:836-43.