Penn M S, Smedira N, Lytle B, Brener S J
Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
J Am Coll Cardiol. 2000 Mar 15;35(4):889-94. doi: 10.1016/s0735-1097(99)00638-5.
To study the relationship between coronary angiography and in-hospital mortality in patients undergoing emergency surgery of the aorta without a history of coronary revascularization or coronary angiography before the onset of symptoms.
In the setting of acute ascending aortic dissection warranting emergency aortic repair, coronary angiography has been considered to be desirable, if not essential. The benefits of defining coronary anatomy have to be weighed against the risks of additional delay before surgical intervention.
Retrospective analysis of patient charts and the Cardiovascular Information Registry (CVIR) at the Cleveland Clinic Foundation.
We studied 122 patients who underwent emergency surgery of the aorta between January 1982 and December 1997. Overall, in-hospital mortality was 18.0%, and there was no significant difference between those who had coronary angiography on the day of surgery compared with those who had not (No: 16%, n = 81 vs. Yes: 22%, n = 41, p = 0.46). Multivariate analysis revealed that a history of myocardial infarction (MI) was the only predictor of in-hospital mortality (relative risk: 4.98 95% confidence interval: 1.48-16.75, p = 0.009); however, coronary angiography had no impact on in-hospital mortality in patients with a history of MI. Furthermore, coronary angiography did not significantly affect the incidence of coronary artery bypass grafting (CABG) during aortic surgery (17% vs. 25%, Yes vs. No). Operative reports revealed that 74% of all CABG procedures were performed because of coronary dissection, and not coronary artery disease.
These data indicate that determination of coronary anatomy may not impact on survival in patients undergoing emergency surgery of the aorta and support the concept that once diagnosed, patients should proceed as quickly as possible to surgery.
研究在无冠状动脉血运重建史或症状发作前未行冠状动脉造影的情况下，接受主动脉急诊手术患者的冠状动脉造影与院内死亡率之间的关系。
在需要急诊主动脉修复的急性升主动脉夹层情况下，冠状动脉造影即使不是必不可少的，也被认为是可取的。确定冠状动脉解剖结构的益处必须与手术干预前额外延迟的风险相权衡。
对克利夫兰诊所基金会的患者病历和心血管信息登记处（CVIR）进行回顾性分析。
我们研究了1982年1月至1997年12月期间接受主动脉急诊手术的122例患者。总体而言，院内死亡率为18.0%，手术当天进行冠状动脉造影的患者与未进行冠状动脉造影的患者之间无显著差异（未进行：16%，n = 81；进行：22%，n = 41，p = 0.46）。多因素分析显示，心肌梗死（MI）病史是院内死亡率的唯一预测因素（相对风险：4.98；95%置信区间：1.48 - 16.75，p = 0.009）；然而，冠状动脉造影对有MI病史患者的院内死亡率没有影响。此外，冠状动脉造影对主动脉手术期间冠状动脉旁路移植术（CABG）的发生率没有显著影响（17%对25%，进行对未进行）。手术报告显示，所有CABG手术中有74%是由于冠状动脉夹层而非冠状动脉疾病进行的。
这些数据表明，确定冠状动脉解剖结构可能不会影响接受主动脉急诊手术患者的生存率，并支持一旦诊断，患者应尽快进行手术的观点。
