Cesena Fernando Henpin Yue, Favarato Desiderio, César Luiz Antônio Machado, de Oliveira Sérgio Almeida, da Luz Protásio Lemos
Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas de Carvalho Aguiar, 44, SP 05403-000, São Paulo, Brazil.
Eur J Cardiothorac Surg. 2004 Feb;25(2):196-202. doi: 10.1016/j.ejcts.2003.11.004.
Since waiting lists for coronary artery bypass graft surgery are common and carry a risk of severe events, the purposes of this study were: (1) to analyse the incidence and temporal distribution of cardiac complications during waiting for elective coronary artery bypass grafting; (2) to identify predictive factors of such complications.
Data were collected from 574 patients referred to surgery from 1 January 1998 to 12 July 2001. Two types of complications were defined: (1) a composite end-point, which included cardiac death, myocardial infarction, unstable angina or hospital admission due to cardiac cause; (2) sudden or any cardiac death. Previous cardiac events, risk factors, clinical features, laboratory exams, non-invasive tests for myocardial ischemia, left ventricular function and coronary anatomy were analysed. Kaplan-Meier method, multivariate Cox regression and Student's t-test were used for statistical analyses.
Median time to surgery was 126 days (5-1022). Among 516 patients consecutively referred to the surgery from 1 January 1998 to 31 December 2000, sudden or cardiac death occurred in 2.5% and the composite end-point in 22.9%. Most complications (72.1%) were observed within 120 days. The main factors predictive of sudden or cardiac death were severe left ventricular dysfunction and heart failure (univariate analysis). Independent predictive factors of the composite end-point were angina, heart failure functional classes and high triglyceride levels.
During long delay for coronary artery bypass surgery, cardiac events are frequent and tend to occur early. Severe left ventricular dysfunction, advanced angina, heart failure functional classes and high triglyceride level must be considered when selection is necessary, in order to diminish morbidity and mortality during the waiting period.
由于冠状动脉搭桥手术的等候名单很常见且存在严重事件风险，本研究的目的是：（1）分析择期冠状动脉搭桥手术等候期间心脏并发症的发生率和时间分布；（2）确定此类并发症的预测因素。
收集了1998年1月1日至2001年7月12日转诊接受手术的574例患者的数据。定义了两种并发症类型：（1）复合终点，包括心源性死亡、心肌梗死、不稳定型心绞痛或因心脏原因住院；（2）猝死或任何心源性死亡。分析了既往心脏事件、危险因素、临床特征、实验室检查、心肌缺血的无创检查、左心室功能和冠状动脉解剖结构。采用Kaplan-Meier法、多变量Cox回归和Student t检验进行统计分析。
手术中位时间为126天（5 - 1022天）。在1998年1月1日至2000年12月31日连续转诊接受手术的516例患者中，猝死或心源性死亡发生率为2.5%，复合终点发生率为22.9%。大多数并发症（72.1%）在120天内出现。猝死或心源性死亡的主要预测因素是严重左心室功能障碍和心力衰竭（单变量分析）。复合终点的独立预测因素是心绞痛、心力衰竭功能分级和高甘油三酯水平。
在冠状动脉搭桥手术长时间延迟期间，心脏事件频繁且往往早期发生。在进行必要的患者选择时，必须考虑严重左心室功能障碍、重度心绞痛、心力衰竭功能分级和高甘油三酯水平，以降低等候期间的发病率和死亡率。
