Fattouch K, Runza G, Moscarelli M, Trumello C, Incalcatera E, Corrado E, La Grutta L, Patni R, Midiri M, Novo S, Ruvolo G
Department of Cardiac Surgery, University of Palermo, Palermo, Italy.
Perfusion. 2011 Sep;26(5):401-8. doi: 10.1177/0267659111411354. Epub 2011 May 31.
The aim of our study was to assess the long-term clinical outcomes and the grafts patency rates of patients with ST-segment elevation myocardial infarction (STEMI) who underwent urgent or emergency coronary artery bypass grafting (CABG).
Participants in two previous studies comprising 207 STEMI patients undergoing on-pump (145 patients) or off-pump (62 patients) coronary artery bypass graft (CABG) surgery in our institution were prospectively followed to assess late mortality, graft patency, and major adverse cardiac-related event (MACE) rates. Graft patency was evaluated by multi-detector computed tomography angiography 64-slice scan. Mean times of graft implantation were 38±16 months and 37±14 months in on-pump and off-pump, respectively. Follow-up data were obtained in all patients and was 100% complete.
Late mortality rate was 7.4% (10 patients) in the on-pump and 6.5% (4 patients) in off-pump groups (p=0.45). Five-year overall survival rate (±SE) was 93.5±2.1% and 92.6±1.9% in the off-pump vs on-pump, respectively. Five years' freedom from cardiac-related death was 94.9±2.9% in the on-pump group vs 96.8±3.2% in the off-pump group (p=0.25). Five years' freedom from cardiac-related events was 89.7±1.6% in the on-pump group versus 93.5±1.8% in the off-pump group (p=0.32). In all patients, a total of 449/491 (91.5%) grafts were patent. Percentages of overall grafts classified as patent were similar in the on-pump group (90.7% - 322/355 conduits) versus the off-pump group (91% - 133/146 conduits). Graft patency rates were also similar between the two groups with regard to arterial and saphenous vein conduits, and with regard to different branches of the coronary arteries grafted.
Our data suggest that off-pump CABG patients have the same late mortality, MACEs, and graft patency rates as conventional cardioplegic cardiac arrest CABG patients. In our opinion, urgent or emergency CABG for patients with STEMI can be done either way.
我们研究的目的是评估接受紧急或急诊冠状动脉旁路移植术（CABG）的ST段抬高型心肌梗死（STEMI）患者的长期临床结局和移植物通畅率。
对之前两项研究中的参与者进行前瞻性随访，这两项研究包括在我们机构接受体外循环（145例患者）或非体外循环（62例患者）冠状动脉旁路移植（CABG）手术的207例STEMI患者，以评估晚期死亡率、移植物通畅率和主要心脏相关不良事件（MACE）发生率。通过64层多排螺旋CT血管造影评估移植物通畅情况。体外循环组和非体外循环组移植物植入的平均时间分别为38±16个月和37±14个月。所有患者均获得随访数据，且完整率为100%。
体外循环组晚期死亡率为7.4%（10例患者），非体外循环组为6.5%（4例患者）（p=0.45）。非体外循环组和体外循环组的五年总生存率（±标准误）分别为93.5±2.1%和92.6±1.9%。体外循环组五年无心脏相关死亡生存率为94.9±2.9%，非体外循环组为96.8±3.2%（p=0.25）。体外循环组五年无心脏相关事件生存率为89.7±1.6%，非体外循环组为93.5±1.8%（p=0.32）。在所有患者中，共有449/491（91.5%）的移植物通畅。体外循环组（90.7% - 322/355根血管）和非体外循环组（91% - 133/146根血管）中分类为通畅的总移植物百分比相似。两组在动脉和大隐静脉血管以及所移植冠状动脉的不同分支方面的移植物通畅率也相似。
我们的数据表明，非体外循环CABG患者与传统心脏停搏CABG患者具有相同的晚期死亡率、MACE发生率和移植物通畅率。我们认为，STEMI患者的紧急或急诊CABG两种方式均可。
