静息心率和脉压是冠状动脉搭桥术后早期并发症的主要预后指标。

Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery.

作者信息

Aboyans Victor, Frank Michael, Nubret Karine, Lacroix Philippe, Laskar Marc

机构信息

Department of Thoracic & Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France.

出版信息

Eur J Cardiothorac Surg. 2008 Jun;33(6):971-6. doi: 10.1016/j.ejcts.2008.01.065. Epub 2008 Apr 8.

DOI:10.1016/j.ejcts.2008.01.065

PMID:18396057

Abstract

OBJECTIVE

There is substantial evidence to consider both heart rate (HR) at rest and pulse pressure (PP) as significant markers of cardiovascular prognosis in the general population. Despite this, neither of these two parameters has been taken into consideration in the design of modern coronary artery bypass risk prediction scores, and little data on their early postoperative prognostic value are currently available. We aimed to assess the predictive value of preoperative HR and PP in the 30-day postoperative period.

METHODS

We prospectively enrolled all patients referred to our institution for non-urgent coronary artery bypass grafting. We measured HR on ECG at admittance. Preoperative pulse pressure was obtained by the difference of the mean of three consecutive systolic and diastolic blood pressures. The primary outcome combined the 30-day postoperative mortality, myocardial infarction (new Q-waves on ECG or Troponin-I >20 microg/l) and stroke or transient ischemic attack. The secondary outcome corresponded to clinical events only (stroke or death). Statistical analysis was performed by usual methods.

RESULTS

We enrolled 1022 patients (age 66.9+/-9.2 years). Those meeting the primary outcome (n=146) had a significantly higher HR (69.9+/-14.3 bpm vs 64.9+/-13.2 bpm, p<0.0001) and a higher proportion presented a PP >70 mmHg (17.1% vs 10.2%, p<0.03). After adjustments for age, gender, systolic blood pressure, preoperative beta-blocker therapy, left ventricular ejection fraction <0.40, unstable cardiac status, redo surgery, peripheral arterial disease, renal failure, and combined vascular surgery, both HR (OR=1.17 per 10 bpm, p<0.03) and PP >70 mmHg (OR=1.99, p=0.03) remained significant risk predictors. Similar results were found when considering only clinical events.

CONCLUSION

This prospective study highlights the usefulness of HR and PP as preoperative risk markers in CABG candidates.

摘要

目的

有大量证据表明，静息心率（HR）和脉压（PP）都是一般人群心血管预后的重要标志物。尽管如此，现代冠状动脉搭桥术风险预测评分的设计中并未考虑这两个参数，目前关于它们术后早期预后价值的数据也很少。我们旨在评估术前HR和PP在术后30天内的预测价值。

方法

我们前瞻性地纳入了所有因非紧急冠状动脉搭桥术转诊至我院的患者。入院时通过心电图测量HR。术前脉压通过连续三次收缩压和舒张压平均值的差值获得。主要结局包括术后30天死亡率、心肌梗死（心电图出现新的Q波或肌钙蛋白-I>20微克/升）、中风或短暂性脑缺血发作。次要结局仅对应临床事件（中风或死亡）。采用常规方法进行统计分析。

结果

我们纳入了1022例患者（年龄66.9±9.2岁）。达到主要结局的患者（n=146）HR显著更高（69.9±14.3次/分钟对64.9±13.2次/分钟，p< /span>0.0001），且PP>70 mmHg的比例更高（17.1%对10.2%，p< /span>0.03）。在调整年龄、性别、收缩压、术前β受体阻滞剂治疗、左心室射血分数<0.40、不稳定心脏状态、再次手术、外周动脉疾病、肾衰竭和联合血管手术后，HR（每10次/分钟OR=1.17，p< /span>0.03）和PP>70 mmHg（OR=1.99，p=0.03）仍然是显著的风险预测因素。仅考虑临床事件时也发现了类似结果。