Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
J Thorac Cardiovasc Surg. 2012 Jan;143(1):103-10. doi: 10.1016/j.jtcvs.2011.05.005. Epub 2011 Jun 15.
Our aim was to determine whether general left main coronary artery stenosis (LMS) and ostial LMS pose additional risks after off-pump coronary artery bypass grafting (CABG) relative to non-left main coronary artery stenosis.
From January 1, 2008, to December 31, 2009, 4366 patients underwent primary isolated off-pump CABG at Beijing Anzhen Hospital. Disease was retrospectively classified as non-left main disease (n = 3523), nonostial LMS (n = 765), and ostial LMS (n = 78). Groups were propensity score matched. Kaplan-Meier freedoms from major adverse cardiac and cerebrovascular events (MACCEs) were calculated.
During the first 30 postoperative days, mortality was significantly higher in the ostial LMS group (6.41%) than in non-left main disease (0.855%, χ(2) = 7.78, P = .005) and nonostial LMS (1.28%, χ(2) = 4.71, P = .03) groups. Incidence of MACCEs was significantly higher in the ostial LMS group (20.5%) than in non-left main disease (5.98%, P = .000) and nonostial LMS (9.62%, P = .002) groups. Odds ratio for early MACCEs of ostial LMS versus non-left main disease was 3.74 (95% confidence interval, 1.72-8.17). At mean follow-up 12.8 ± 7.5 months and cumulative follow-up 498.5 patient-years, difference among groups in freedom from MACCEs did not reach statistical significance (χ(2) = 2.39, P = .303).
Ostial LMS poses additional early risks of mortality and MACCEs in off-pump CABG. Off-pump CABG for ostial LMS should proceed with greater of intraoperative surveillance and lower threshold for converting to on-pump CABG.
我们的目的是确定左主干冠状动脉狭窄（LMS）和开口 LMS 相对于非左主干冠状动脉狭窄在非体外循环冠状动脉旁路移植术（CABG）后是否会增加额外风险。
2008 年 1 月 1 日至 2009 年 12 月 31 日，北京安贞医院对 4366 例患者进行了原发性单纯非体外循环 CABG。回顾性将疾病分为非左主干疾病（n=3523）、非开口 LMS（n=765）和开口 LMS（n=78）。通过倾向评分匹配。计算 Kaplan-Meier 主要不良心脏和脑血管事件（MACCEs）的无事件生存率。
在术后 30 天内，开口 LMS 组（6.41%）的死亡率明显高于非左主干疾病组（0.855%，χ(2)=7.78，P=0.005）和非开口 LMS 组（1.28%，χ(2)=4.71，P=0.03）。开口 LMS 组 MACCEs 的发生率明显高于非左主干疾病组（20.5%）和非开口 LMS 组（9.62%）。开口 LMS 与非左主干疾病的早期 MACCEs 的优势比为 3.74（95%置信区间，1.72-8.17）。在平均随访 12.8±7.5 个月和累积随访 498.5 患者年时，各组间 MACCE 无事件生存率差异无统计学意义（χ(2)=2.39，P=0.303）。
开口 LMS 在非体外循环 CABG 中增加了早期死亡率和 MACCEs 的风险。对于开口 LMS，应增加术中监测，并降低转为体外循环 CABG 的阈值。
