Department of Cardiovascular Surgery, University of Giessen, Germany.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):e53-7. doi: 10.1016/j.jtcvs.2011.04.018.
A negative relationship between coronary stenting before coronary artery bypass graft (CABG) surgery and the perioperative mortality and morbidity has been shown in diabetic patients. We tried to assess this relationship in a 2-institution database.
In the years 2005 and 2006, 1125 of 3311 patients undergoing CABG surgery had diabetes mellitus (33.9%), and 185 (16.4%) of the diabetic patients had at least 1 previous stent. There was no evidence of any clinically significant difference in the preoperative and intraoperative parameters between diabetics with or without previous stents.
Thirty-day mortality (no-stent group, 3.86%; stent group, 1.62%) and postoperative major adverse cardiovascular and cerebrovascular events (MACCEs; mortality, stroke, myocardial infarction, renal failure) (no-stent group, 12.2%; stent group, 5.9%) occurred more often in diabetic patients without coronary stents. Logistic regression for 30-day mortality using possible confounders including preoperative stent showed a significant positive effect of preoperative coronary stenting (OR, 0.157; 95% CI limits, 0.033-0.737). Taking percutaneous coronary intervention out of the calculation model, this positive effect was no longer significant (OR, 0.344; CI, 0.091-1.298). Logistic regression for perioperative MACCE, with as well as without percutaneous coronary intervention as a confounder, also showed a significant positive effect of preoperative coronary stenting (OR, 0.231; 95% CI, 0.091-0.590).
Coronary stenting before CAGB in diabetic patients does not predispose to a higher perioperative risk regarding mortality and morbidity after CABG surgery.
先前的研究表明，在接受冠状动脉旁路移植术（CABG）的糖尿病患者中，冠状动脉支架置入术与围手术期死亡率和发病率呈负相关。我们试图在一个 2 家机构的数据库中评估这种关系。
在 2005 年和 2006 年，3311 例接受 CABG 手术的患者中有 1125 例（33.9%）患有糖尿病，其中 185 例（16.4%）糖尿病患者至少有 1 次支架置入史。支架组和无支架组患者的术前和术中参数无明显差异。
无支架组患者 30 天死亡率（3.86%）和术后主要不良心血管和脑血管事件（MACCEs；死亡率、卒中和心肌梗死、肾衰竭）（12.2%）发生率明显高于无支架组（5.9%）。使用可能的混杂因素（包括术前支架）进行 30 天死亡率的逻辑回归分析显示，术前冠状动脉支架置入术有显著的正效应（OR，0.157；95%CI 下限，0.033-0.737）。将经皮冠状动脉介入治疗排除在计算模型之外后，这种正效应不再显著（OR，0.344；CI，0.091-1.298）。考虑经皮冠状动脉介入治疗作为混杂因素，对围手术期 MACCE 进行逻辑回归分析，也显示术前冠状动脉支架置入术有显著的正效应（OR，0.231；95%CI，0.091-0.590）。
在接受 CABG 的糖尿病患者中，在 CAGB 前进行冠状动脉支架置入术并不会增加 CABG 术后死亡率和发病率的围手术期风险。
