Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Ann Thorac Surg. 2010 Aug;90(2):528-33. doi: 10.1016/j.athoracsur.2010.03.112.
Compared with non-ST-elevation myocardial infarction (MI), ST-elevation MI has been associated with increased mortality after medical treatment and percutaneous coronary intervention. Our study investigated the prognostic value of MI classification in the setting of surgical revascularization within 21 days of MI.
We studied 2412 consecutive patients between 1995 and 2007 who underwent an isolated coronary artery bypass grafting procedure within 21 days after MI. The outcomes of interest were in-hospital mortality and major adverse events, which included death, MI, stroke, and renal failure requiring hemodialysis.
Rates of crude in-hospital mortality and major adverse events were higher in ST-elevation MI patients. Stepwise regression analysis suggested that MI subtype (ST-elevation MI vs non-ST-elevation MI) did not predict in-hospital mortality or major adverse events. A secondary analysis using propensity score matching showed similar surgical outcomes between the two cohorts.
Surgical risks of patients with recent MI are independent of MI subtype. Distinguishing ST-elevation MI and non-ST-elevation MI is of limited value in the decision-making process of early surgical intervention.
与非 ST 段抬高型心肌梗死（MI）相比，ST 段抬高型 MI 与药物治疗和经皮冠状动脉介入治疗后的死亡率增加相关。我们的研究调查了 MI 分类在 MI 后 21 天内进行手术血运重建情况下的预后价值。
我们研究了 1995 年至 2007 年间连续 2412 例 MI 后 21 天内接受单纯冠状动脉旁路移植术的患者。主要观察终点为住院期间死亡率和主要不良事件，包括死亡、MI、卒中和需要血液透析的肾功能衰竭。
ST 段抬高型 MI 患者的住院期间死亡率和主要不良事件发生率较高。逐步回归分析表明，MI 亚型（ST 段抬高型 MI 与非 ST 段抬高型 MI）不能预测住院期间死亡率或主要不良事件。使用倾向评分匹配的二次分析显示，两组的手术结果相似。
近期 MI 患者的手术风险与 MI 亚型无关。在早期手术干预的决策过程中，区分 ST 段抬高型 MI 和非 ST 段抬高型 MI 的价值有限。
