Cardiac Surgery Unit, Civic Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
Eur J Cardiothorac Surg. 2010 Nov;38(5):585-91. doi: 10.1016/j.ejcts.2010.03.017.
The aim of this multicentre study was to determine whether the prophylactic use of intra-aortic balloon pump (IABP) translates into better early and long-term results in high-risk patients undergoing cardiac surgery.
From January 2000 to March 2009, 6121 high-risk patients (EuroSCORE >8), at six different institutions, underwent cardiac surgery. Propensity-score computer matching was performed, based on 10 variables representing patients characteristics and preoperative risk factors to correct for and minimise selection bias (Hosmer-Lemeshow goodness of fit, p=0.3; c=0.94). A total of 956 patients were successfully matched and consisted of 478 pairs either undergoing preoperative IABP (group A) or not receiving IABP preoperatively (group B).
Multivariate logistic regression (odds ratio) revealed that group B had a 64% higher risk of in-hospital mortality (p=0.001), 57% higher risk of 30-day mortality (p=0.003), 45% higher risk of perioperative myocardial infarction (p=0.01), 57% higher risk of postoperative low-output syndrome (p=0.003), 45% higher risk of intensive care unit (ICU) length of stay (p=0.001) and 44% higher risk of hospital length of stay (p=0.001). Patients in group A showed, at follow-up, significant improvements in left ventricular (LV) ejection fraction (p<0.001), wall-motion score index (p<0.001) and LV dimensions (p<0.001). Five- and 8-year survivals did not differ between groups (5-year survival: 91.7 ± 3.1% vs 95 ± 2.1% in groups A and B, respectively, log-rank p=0.34; 8-year survival: 84.3 ± 5.5% vs 85.9 ± 6.1% in groups A and B, respectively, log-rank p=0.2).
Prophylactic IABP support, in this multicentre experience, was showed to enhance perioperative management and outcome of high-risk cardiac surgery patients.
本多中心研究旨在确定高危患者在心脏手术后使用主动脉内球囊泵（IABP）预防性治疗是否会带来更好的早期和长期结果。
2000 年 1 月至 2009 年 3 月，在六家不同机构中，6121 名高危患者（EuroSCORE>8）接受了心脏手术。基于 10 个代表患者特征和术前危险因素的变量进行了倾向评分计算机匹配，以纠正和最小化选择偏倚（Hosmer-Lemeshow 拟合优度，p=0.3；c=0.94）。共有 956 名患者成功匹配，分为接受术前 IABP（A 组）和未接受术前 IABP（B 组）的 478 对。
多变量逻辑回归（比值比）显示，B 组院内死亡率风险增加 64%（p=0.001），30 天死亡率风险增加 57%（p=0.003），围手术期心肌梗死风险增加 45%（p=0.01），术后低心排综合征风险增加 57%（p=0.003），重症监护病房（ICU）住院时间风险增加 45%（p=0.001），住院时间风险增加 44%（p=0.001）。A 组患者在随访时左心室（LV）射血分数（p<0.001）、壁运动评分指数（p<0.001）和 LV 尺寸（p<0.001）均有显著改善。两组患者 5 年和 8 年生存率无差异（5 年生存率：A 组和 B 组分别为 91.7±3.1%和 95±2.1%，对数秩检验 p=0.34；8 年生存率：A 组和 B 组分别为 84.3±5.5%和 85.9±6.1%，对数秩检验 p=0.2）。
本多中心研究表明，高危心脏手术患者预防性使用 IABP 支持可改善围手术期管理和预后。
