Valley-Columbia Heart Center, Ridgewood, New Jersey 07450, USA.
Ann Thorac Surg. 2010 Jan;89(1):19-23. doi: 10.1016/j.athoracsur.2009.07.076.
Stroke remains an important complication after coronary artery bypass graft surgery (CABG). We sought to determine the frequency and death-related incidence of stroke after on-pump and off-pump CABG.
We analyzed 4,869 consecutive isolated CABG performed in our institution. Of these, 3,490 (71.7%) were off-pump and 1,379 (28.3%) were on-pump. Propensity matched samples of 1,379 off-pump and 1,379 on-pump were compared on clinical presentation and The Society of Thoracic Surgeons (STS) predicted scores for risk of postoperative mortality and stroke. Univariate analyses were used to compare the relationship of off-pump and on-pump groups to postoperative mortality and stroke. Multivariate logistic regression was used to determine the unique association between all variables and occurrence of mortality after stroke.
No differences were found for sex, diabetes mellitus, history of renal failure, prior stroke, or timing of surgery. Postoperative mortality occurred in 75 patients (2.7%) and stroke in 47 (1.7%). The off-pump patients had a lower rate of stroke (1.0% versus 2.4%; p < 0.01) compared with on-pump patients. Mortality after stroke occurred in 14 patients, with a lower rate occurring in the off-pump group (14.3% versus 36.4%; p = 0.07). Multivariate analyses controlling for the effect of preoperative risk factors and STS mortality risk demonstrated that off-pump status was independently associated with an 84% decrease in the risk of death after stroke (adjusted odds ratio 0.157, 95% confidence interval: 0.035 to 0.711, p = 0.016).
Off-pump CABG is associated with lower stroke rates and stroke-related mortality. It may be useful to consider off-pump CABG for patients who are at higher risk for postoperative stroke.
中风仍然是冠状动脉旁路移植术（CABG）后的一个重要并发症。我们旨在确定体外循环和非体外循环 CABG 后中风的频率和与死亡相关的发生率。
我们分析了我院连续进行的 4869 例单独 CABG。其中，3490 例（71.7%）为非体外循环，1379 例（28.3%）为体外循环。对 1379 例非体外循环和 1379 例体外循环的倾向性匹配样本进行比较，比较临床特征和胸外科医生协会（STS）预测术后死亡率和中风风险的评分。使用单变量分析比较非体外循环和体外循环组与术后死亡率和中风的关系。多变量逻辑回归用于确定所有变量与中风后死亡率之间的独特关联。
在性别、糖尿病、肾衰竭史、既往中风史或手术时间方面无差异。75 例患者（2.7%）发生术后死亡，47 例（1.7%）发生中风。非体外循环患者中风发生率较低（1.0%比 2.4%；p < 0.01）。体外循环组发生中风后死亡率为 14 例，非体外循环组死亡率较低（14.3%比 36.4%；p = 0.07）。多变量分析控制术前危险因素和 STS 死亡率的影响表明，非体外循环状态与中风后死亡风险降低 84%独立相关（调整后的优势比 0.157，95%置信区间：0.035 至 0.711，p = 0.016）。
非体外循环 CABG 与较低的中风发生率和中风相关死亡率相关。对于术后中风风险较高的患者，考虑非体外循环 CABG 可能是有用的。
