Joskowiak D, Szlapka M, Kappert U, Matschke K, Tugtekin S M
Department of Cardiac Surgery, Heart Center Dresden Ltd. University Hospital, Dresden, Germany.
Thorac Cardiovasc Surg. 2011 Oct;59(7):406-10. doi: 10.1055/s-0030-1250728. Epub 2011 Mar 25.
Intra-aortic balloon pump (IABP) is an established therapy to support patients with heart failure during coronary artery bypass grafting (CABG). The impact of the timing of IABP on the hospital course and on follow-up is of particular clinical interest. The purpose of this study was to analyze the relationship between the time of IABP implantation and its impact on early, mid- and long-term survival in patients with acute myocardial infarction (AMI) who underwent emergent CABG for NSTEMI and STEMI.
A total of 472 patients with AMI (NSTEMI and STEMI) underwent emergency CABG at our institution; 158 of them additionally received IABP support. Fifty-seven (36 %) patients received preoperative and 101 (64 %) patients underwent intraoperative IABP implantation. Endpoints were in-hospital und follow-up (mean duration 37 ± 28 months) survival.
Overall in-hospital mortality was 17.1 % (n = 27): 17.6 % (n = 10) in the preoperative group and 16.8 % (n = 17) in the intraoperative group ( P = ns). Mid- and long-term survival rates were comparable for both groups 78.6 % vs. 73.7 %, 71.4 % vs. 68.7 % and 64.3 % vs. 54.6 % at 1, 3 and 5 years, respectively ( P = ns).
This study demonstrates that CABG with IABP support in high-risk patients with AMI can be performed with acceptable in-hospital and long-term survival rates. The decision for IABP placement should consider the preoperative clinical condition and the intraoperative course of each patient. IABP placement does not appear to affect the long-term outcome after isolated CABG in patients with AMI.
主动脉内球囊反搏（IABP）是一种用于在冠状动脉旁路移植术（CABG）期间支持心力衰竭患者的既定治疗方法。IABP植入时机对住院病程及随访的影响具有特殊的临床意义。本研究的目的是分析IABP植入时间与急性心肌梗死（AMI）患者早期、中期和长期生存的关系，这些患者因非ST段抬高型心肌梗死（NSTEMI）和ST段抬高型心肌梗死（STEMI）接受了急诊CABG。
共有472例AMI（NSTEMI和STEMI）患者在我院接受了急诊CABG；其中158例还接受了IABP支持。57例（36%）患者接受术前IABP支持，101例（64%）患者接受术中IABP植入。观察终点为住院期间及随访（平均时长37±28个月）生存率。
总体住院死亡率为17.1%（n = 27）：术前组为17.6%（n = 10），术中组为16.8%（n = 17）（P = 无统计学意义）。两组的中期和长期生存率相当，1年、3年和5年时分别为78.6%对73.7%、71.4%对68.7%和64.3%对54.6%（P = 无统计学意义）。
本研究表明，在高危AMI患者中，IABP支持下的CABG可获得可接受的住院及长期生存率。IABP植入的决策应考虑每位患者的术前临床状况及术中过程。IABP植入似乎不影响AMI患者单纯CABG后的长期预后。
