Moore Graham J, Trachiotis Gregory D
Department of Surgery, Veterans Affairs Medical Center and The George Washington University, Washington, DC, USA.
Heart Surg Forum. 2006;9(5):E774-8. doi: 10.1532/HSF98.20061073.
Patients with end-stage renal disease (ESRD) and myocardial infarction (MI) have poor survival. Coronary artery bypass grafting (CABG) in select patients is an effective treatment strategy; however, whether operative technique influences hospital outcome is not defined.
Between 1995 and 2000, 342 patients had ESRD (creatinine >2.0 mg/dL or dialysis) and a history of MI at the time of CABG. There were 67 patients that had off-pump coronary artery bypass (OPCAB) (OFF) and 275 that had CABG (ON). The OFF group was compared to the ON group for clinical, operative, outcome data, and influence of acuity of MI.
The OFF group was older (P = .09), but hypertension was more common in the ON group (82% versus 69%, P = .02). The frequency of diabetes, congestive heart failure, peripheral vascular disease, and dyslipidemia were common, but not different between groups. For the OFF versus ON group, creatinine serum level was 3.6 +/- 2.6 versus 3.5 +/- 3.1 (P = 0.17), and history of an acute MI was 39% versus 33% (P = 0.78). The OFF versus ON group had fewer total grafts (2.5 +/- 1 versus 3.8 +/- 1, P < .001). The OFF group had fewer strokes (P = .08), shorter intensive care unit stay (2.4 versus 3.8 days), and shorter hospitalization (8.4 versus 11.7 days), yet mortality was similar (7% versus 9%, P = .79). After acute MI, OFF patients had significantly more postoperative supraventricular tachycardia than ON (69% versus 19%, P < .001).
Patients with ESRD and an MI have acceptable hospital outcomes regardless of operative strategy. OPCAB or CABG may provide an advantage in certain patients, yet it is the presence of an acute MI that is a predictor of postoperative events.
终末期肾病（ESRD）患者合并心肌梗死（MI）时生存率较低。对部分患者进行冠状动脉旁路移植术（CABG）是一种有效的治疗策略；然而，手术技术是否会影响住院结局尚不明确。
1995年至2000年间，342例患者在进行CABG时患有ESRD（肌酐>2.0mg/dL或接受透析）且有MI病史。其中67例患者接受非体外循环冠状动脉旁路移植术（OPCAB）（OFF组），275例患者接受CABG（ON组）。将OFF组与ON组在临床、手术、结局数据以及MI严重程度的影响方面进行比较。
OFF组患者年龄较大（P = 0.09），但ON组高血压更为常见（82%对69%，P = 0.02）。糖尿病、充血性心力衰竭、外周血管疾病和血脂异常的发生率较高，但两组之间无差异。OFF组与ON组相比，血清肌酐水平分别为3.6±2.6和3.5±3.1（P = 0.17），急性MI病史分别为39%和33%（P = 0.78）。OFF组与ON组相比，总的移植血管较少（2.5±1对3.8±1，P < 0.001）。OFF组中风较少（P = 0.08），重症监护病房停留时间较短（2.4天对3.8天），住院时间较短（8.4天对11.7天），但死亡率相似（7%对9%，P = 0.79）。急性MI后，OFF组患者术后室上性心动过速明显多于ON组（69%对19%，P < 0.001）。
无论手术策略如何，ESRD合并MI患者的住院结局均可接受。OPCAB或CABG可能在某些患者中具有优势，但急性MI的存在是术后事件的预测因素。
