31 A Direct Comparison of Early and Late Outcomes With Three Approaches to Carotid Revascularization and Open Heart Surgery J Am Coll Cardiol 2013;62:1948 56 開 心 手 術 與 頸 動 脈 狹 窄 再 灌 流 治 療, 三 種 治 療 方 案 對 於 早 期 與 晚 期 結 果 之 比 較 翻 譯 : 江 亮 霆 蔡 佳 醍 (carotid endarterectomy, CEA) (open heart surgery, OHS) (Carotid artery stenting, CAS) 1997-2009 (Cleveland Clinic) 350 90 45 195 110 (primary endpoint) (p = 0.03) (propensity score) (adjusted hazard ratio: 0.33; 95% confidence interval: 0.15 to 0.77; p = 0.01)
32 醫 學 新 知 (I) (adjusted hazard ratio: 0.35; 95% confidence interval: 0.18 to 0.70; p = 0.003) ----------------------------------------------------------------------------------------------------------------------------------- ( 80% ) 6-12% (1,2) (3-5) (6) (4,7) (8,9) 30 1997 1 2009 8 Cleveland Clinic 350 90 45 195 110 41 (12%) 25 (7%) 66 (19%) ( [TIA, transient ischemic attack] ) ( ) 27 (8%)
33 (82%) (creatine kinase myocardial band or troponin T) 24 24 3 4 (aspirin and clopidogrel) (Endpoints) 3.7 7 25% 10 10% 24 72 (creatine kinase myocardial band or troponin T) 5 Q (10) 3 ST 1mm ICD (International Classification of Diseases codes) (11) (12) 90 Cleveland Clinic REDCap (13) Social Security number the Social Security Death Index (SSDI)( 14,15) Cleveland Clinic (intention-to-treat analysis) SSDI 90
34 醫 學 新 知 (I) chi-square test for categorical variables Kruskal-Wallis nonparametric test for continuous variables 3 (Table 1) 80%-99% (p = 0.03) (p = 0.01) (p = 0.02) (p = 0.003) (propensity score) 31 (polytomous logistic regression analysis) Kaplan-Meier (Fig. 1) (16) 0 (modulated renewal method) 5 (1)CAS OHS (2) CAS OHS (3)CEA OHS (4) CEA OHS (5) CEA OHS (hazard ratio, HR) 95% (confidence interval, CI) CEA CAS OHS (Fig. 2) 3 5-fold multiple imputation (18) CEA-OHS CAS-OHS 32 71% CEA-OHS Hazard plots (Fig.3) SAS 9.2
35
36 醫 學 新 知 (I)
37 CEA-OHS 14 (interquartile range, 6 to 43) CAS-OHS 47 (interquartile range, 39 to 61) 9 3 CEA-OHS 6 CAS-OHS (p = 0.77)(Table 2) CEA-OHS CAS-OHS (24% vs. 3%; p < 0.001) (Table 2) (p < 0.001)(Table 2, Gig.1D) CAS-OHS (Table 3) (adjusted HR: 0.33, 95% CI: 0.11 to 0.96; p = 0.04) CEA (Fig.2A)OHS CAS-OHS (Fig.2B) CEA-OHS (adjusted HR: 5.47, 95% CI: 1.98 to 15.17; p = 0.001) CAS-OHS (adjusted HR: 0.95, 95% CI: 0.37 to 2.48; p = 0.92) OHS 30 CAS-OHS CEA OHS CEA-OHS (p = 0.003) CEA-OHS
38 醫 學 新 知 (I) (p < 0.001)(Table 2) CAS-OHS CEA OHS 30 ( ) (Table 2) (Fig 3A) 1 3 CEA-OHS (Table 2) CAS-OHS CEA-OHS (adjusted HR: 0.99, 95% CI: 0.61 to 1.62; p = 0.97)(Table 3) CEA-OHS CEA-OHS CEA-OHS (adjusted HR: 3.74, 95% CI: 1.78 to 7.89; p < 0.001) CAS-OHS (adjusted HR: 0.76, 95% CI: 0.33 to 1.76; p = 0.52) (Table 3) 3 1 CAS-OHS CEA OHS (adjusted HR: 0.35, 95% CI: 0.18 to 0.70; p = 0.003) CEA-OHS (adjusted HR: 0.33, 95%
39
40 醫 學 新 知 (I) CI: 0.15 to 0.77; p = 0.01) (Table 3) CEA OHS CEA-OHS (adjusted HR: 1.05, 95% CI: 0.57 to 1.96; p = 0.87)(Table 3) CAS- OHS CEA OHS 12 CAS-OHS CEA-OHS CAS-OHS CEA OHS CAS-OHS CEA OHS (Table 2) CAS-OHS (Table 2 and 3) CAS-OHS CEA OHS (7% vs. 2%) 1 (8.7% vs. 1.8%) 1 30 CEA-OHS CAS CEA OHS (7,8,9) Ziada (8) CAS-OHS (n = 56) CEA OHS (n = 112) 30 CAS-OHS (p = 0.06) (p = 0.12) CEA-OHS (82% vs. 14%) Timaran (9) National Inpatient Sample (NIS) CAS- OHS (n = 887) CEA OHS (n = 26,197) CEA OHS 66% CEA OHS CAS-OHS (p = 0.06) Gopaldas (7) NIS CEA-OHS CEA OHS CAS-OHS 3% CAS-OHS (9) CEA OHS CAS-OHS 3 4
41 CEA OHS 76% NIS 77%(9) CAS-OHS 3 4 CAS-OHS CAS 1997 CEA CAS 90 SSDI ( )