非 ST 段抬高型心肌梗死患者行急诊冠状动脉旁路移植术的当代转归：急诊冠状动脉旁路移植术始终优于全球急性冠状动脉事件注册预测的生存率。

Contemporary outcomes of urgent coronary artery bypass graft surgery following non-ST elevation myocardial infarction: urgent coronary artery bypass graft surgery consistently outperforms Global Registry of Acute Coronary Events predicted survival.

出版信息

Eur J Cardiothorac Surg. 2012 May;41(5):e87-91; discussion e91-2. doi: 10.1093/ejcts/ezr303. Epub 2012 Feb 29.

Abstract

OBJECTIVES

The Global Registry of Acute Coronary Events (GRACE) registry reported that the in-hospital risk of death from non-ST elevation myocardial infarction (NSTEMI) is 5%, with an 11% mortality by 6 months. Prospective Registry of Acute Ischaemic Syndromes in the UK demonstrated that the overall risk of death from NSTEMI over 4 years is 25%. In GRACE, while 28% of patients received percutaneous intervention, only 10% received coronary artery bypass graft (CABG). Results of urgent CABG surgery following NSTEMI are difficult to interpret as these often include patients who have had STEMIs and urgent surgery. With increasing multidisciplinary assessment of patients with acute coronary syndromes (ACS), accurate data collection on the outcome of such patients could inform correct revascularization strategy.

METHODS

Three hundred and forty-two consecutive patients who had undergone urgent CABG from April 2004 to April 2009 at a single institution were identified. The GRACE predicted mortality was calculated from hospital records and patients categorized into three groups based upon their predicted risk. Late survival data were obtained from the UK Office of National Statistics.

RESULTS

The GRACE score could be calculated in 270 patients with a confirmed diagnosis of NSTEMI. Of the 304 probable patients with NSTEMI, there were 5 in-hospital deaths (1.6%). Survival at 6 months was higher than GRACE predicted mortality in all groups. At 6 months the predicted versus observed mortality in the low-risk group was 4 versus 2% (P = 0.05), in the medium-risk group it was 12.5 versus 1.9% (P = 0.0001) and in the high-risk group it was 25 versus 20% (P = 0.45).

CONCLUSIONS

In-hospital CABG performed after NSTEMI is associated with a low-mortality risk and survival significantly better than that predicted by the GRACE score.

摘要

目的

全球急性冠状动脉事件注册（GRACE）登记报告称，非 ST 段抬高型心肌梗死（NSTEMI）患者住院期间的死亡风险为 5%，6 个月时死亡率为 11%。英国急性缺血性综合征前瞻性登记显示，NSTEMI 患者 4 年内的总体死亡风险为 25%。在 GRACE 中，尽管 28%的患者接受了经皮介入治疗，但只有 10%的患者接受了冠状动脉旁路移植术（CABG）。NSTEMI 后紧急 CABG 手术的结果难以解释，因为其中通常包括发生 ST 段抬高型心肌梗死并接受紧急手术的患者。随着对急性冠状动脉综合征（ACS）患者进行多学科评估的增加，准确收集此类患者的结果数据可以为正确的血运重建策略提供信息。

方法

在一个机构中，从 2004 年 4 月至 2009 年 4 月，连续确定了 342 例接受紧急 CABG 的患者。从医院记录中计算了 GRACE 预测死亡率，并根据患者的预测风险将其分为三组。通过英国国家统计局获得晚期生存数据。

结果

在 270 例确诊为 NSTEMI 的患者中，可以计算出 GRACE 评分。在 304 例可能患有 NSTEMI 的患者中，有 5 例院内死亡（1.6%）。在所有组中，6 个月时的生存率均高于 GRACE 预测死亡率。在低危组中，预测死亡率与实际死亡率的比值为 4 比 2%（P=0.05），中危组为 12.5 比 1.9%（P=0.0001），高危组为 25 比 20%（P=0.45）。