van Eck Frans M, Noyez Luc, Verheugt Freek W A, Brouwer Rene M H J
Department of Thoracic and Cardiac Surgery, Heart Center, University of Nijmegen Medical Center, St. Radboud, Nijmegen, The Netherlands.
Ann Thorac Surg. 2002 Dec;74(6):2106-12. doi: 10.1016/s0003-4975(02)03986-3.
Identify risk factors associated with mortality following repeat coronary revascularization (redoCABG) within the first 6 months following surgery.
Five hundred forty-one redoCABG patients (1987 to 1998) were studied by univariant and multivariant analysis. Mortality was assessed at three different points: hospital mortality (A) (36/541, 6.7%); mortality at 6 months (C) (75/541, 13.9%); and outpatient perioperative mortality, which is a death occurring from the time of hospital discharge to 6 months postoperatively (B) (39/541, 7.2%).
Diabetes, hypertension, peripheral vascular disease, renal insufficiency, lung disease, myocardial infarction (MI) before the first operation, MI between the first and redoCABG, lack of sinus rhythm, no IMA graft, acute/emergency operation, perfusion time, and perioperative MI were all identified as risk factors related to early mortality. MI before the first operation, antegrade cardioplegia, and the time period 1987 to 1992 all influenced hospital mortality (A). Diabetes, hypertension, renal insufficiency, lung disease, and valvular heart disease all influenced the outpatient mortality up to 6 months. Independent predictive factors for early mortality were: age more than 69 years; diabetes; vascular insufficiency; chronic lung disease; MI between first and redoCABG; no IMA-graft; acute preoperative MI; emergency operation; perfusion time; perioperative MI; and the time period 1987 to 1992. Risk factors for in-hospital death included MI between the first and redoCABG, cardiopulmonary bypass time, and the time period 1987 to 1992. Diabetes is an important risk factor during the outpatient perioperative phase. Emergency surgery and perioperative MI predict mortality regardless of the time period (A, B, or C).
Early mortality after redoCABG is influenced by many variables during the first 6 months following surgery. Understanding these factors and their time course may better help to assess the true risk associated with reoperation for recurrent coronary insufficiency.
确定再次冠状动脉血运重建术（再次冠状动脉旁路移植术，redoCABG）术后6个月内与死亡相关的危险因素。
对541例redoCABG患者（1987年至1998年）进行单因素和多因素分析。在三个不同时间点评估死亡率：住院死亡率（A）（36/541，6.7%）；6个月时的死亡率（C）（75/541，13.9%）；以及门诊围手术期死亡率，即从出院至术后6个月期间发生的死亡（B）（39/541，7.2%）。
糖尿病、高血压、外周血管疾病、肾功能不全、肺部疾病、首次手术前的心肌梗死（MI）、首次手术与redoCABG之间的MI、无窦性心律、无胸廓内动脉（IMA）移植、急诊手术、灌注时间和围手术期MI均被确定为与早期死亡相关的危险因素。首次手术前的MI、顺行性心脏停搏以及1987年至1992年期间均影响住院死亡率（A）。糖尿病、高血压、肾功能不全、肺部疾病和心脏瓣膜病均影响至6个月的门诊死亡率。早期死亡的独立预测因素为：年龄超过69岁；糖尿病；血管功能不全；慢性肺部疾病；首次手术与redoCABG之间的MI；无IMA移植；术前急性MI；急诊手术；灌注时间；围手术期MI；以及1987年至1992年期间。住院死亡的危险因素包括首次手术与redoCABG之间的MI、体外循环时间以及1987年至1992年期间。糖尿病是门诊围手术期的重要危险因素。急诊手术和围手术期MI无论在哪个时间段（A、B或C）均预测死亡率。
redoCABG术后早期死亡率在术后6个月内受多种变量影响。了解这些因素及其时间进程可能有助于更好地评估复发性冠状动脉供血不足再次手术的真正风险。
