Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2012 Feb;27(2):153-9. doi: 10.3346/jkms.2012.27.2.153. Epub 2012 Jan 27.
There is no consensus as to which acute myocardial infarction subtype poses a greater risk after coronary artery bypass grafting (CABG). We compared the early and the long term results of off-pump coronary artery bypass grafting (OPCAB) between patients with STEMI (group I, n = 83), and NSTEMI (group II, n = 237). Group I had higher EuroSCORE, prevalence of emergency surgery, preoperative intra-aortic balloon pump use, preoperative emergency percutaneous transluminal coronary angioplasty, and preoperative thrombolytic use than group II. There were no significant differences in 30-day mortality and major adverse cardiac and cerebrovascular event (MACCE) between groups. Overall 8-yr survival was 93% and 87% in groups I and II, respectively. Freedom from MACCE after 8 yr was 92% and 93% in groups I and II, respectively. After propensity score matching analysis, there were no significant differences in preoperative parameters, postoperative in-hospital outcomes, and long-term clinical outcomes. Surgical results of OPCAB in patients with acute myocardial infarction show good results in terms of long-term survival and freedom from MACCE, with no significant differences in clinical outcomes between STEMI and NSTEMI groups.
对于在冠状动脉旁路移植术（CABG）后哪种急性心肌梗死亚型风险更大，目前尚无共识。我们比较了急性 ST 段抬高型心肌梗死（STEMI）患者（I 组，n = 83）和非 ST 段抬高型心肌梗死（NSTEMI）患者（II 组，n = 237）行非体外循环冠状动脉旁路移植术（OPCAB）的早期和长期结果。I 组的 EuroSCORE、急诊手术、术前主动脉内球囊泵使用、术前急诊经皮冠状动脉腔内成形术和术前溶栓治疗的发生率均高于 II 组。两组间 30 天死亡率和主要心脏和脑血管不良事件（MACCE）无显著差异。I 组和 II 组的 8 年总生存率分别为 93%和 87%。I 组和 II 组的 8 年 MACCE 无事件生存率分别为 92%和 93%。经过倾向评分匹配分析，两组间术前参数、术后住院期间结局和长期临床结局均无显著差异。急性心肌梗死患者行 OPCAB 的手术结果显示，在长期生存和无 MACCE 方面均取得了良好的效果，STEMI 和 NSTEMI 组之间的临床结局无显著差异。
