Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1577-83, 1583.e1. doi: 10.1016/j.jtcvs.2012.05.043. Epub 2012 Jun 15.
The aim of the present study was to determine the early and long-term outcomes of coronary artery bypass grafting in patients with acute coronary syndrome and stable angina pectoris.
From September 2004 to September 2011, 382 patients with acute coronary syndrome (unstable angina pectoris and non-ST-segment elevation myocardial infarction) and 851 patients with stable angina pectoris underwent first-time isolated coronary artery bypass grafting at our institute. The early and long-term outcomes were compared between the 2 groups.
Patients with acute coronary syndrome were older, were more likely to be women, had a smaller body surface area, and were more likely to have left main coronary artery disease. In both groups, bilateral internal thoracic artery grafts were used in approximately 89% of the patients, and off-pump techniques in approximately 97% of the patients. The acute coronary syndrome group had a greater operative death rate (2.6% vs 0.1%) and a greater incidence of low output syndrome (3.1% vs 1.2%) and hemodialysis requirement (2.9% vs 1.1%). Multivariate regression analysis demonstrated that age, acute coronary syndrome, lower ejection fraction, and higher creatinine level before surgery were independent predictors of operative death. However, among the hospital survivors, no differences were seen in freedom from all death (85.4% ± 2.5% vs 87.7% ± 2.0%), cardiac death (97.4% ± 0.9% vs 96.5% ± 0.9%), or major adverse cardiac and cerebrovascular events (78.0% ± 2.9% vs 78.1% ± 2.3%) at 7 years between the patients with acute coronary syndrome and stable angina pectoris.
Although acute coronary syndrome is an independent predictor of early mortality in patients undergoing coronary artery bypass grafting, the long-term outcomes after surgery were similar between patients with acute coronary syndrome and stable angina pectoris who survived the early postoperative period.
本研究旨在比较急性冠状动脉综合征（不稳定型心绞痛和非 ST 段抬高型心肌梗死）和稳定型心绞痛患者行冠状动脉旁路移植术的早期和长期结果。
2004 年 9 月至 2011 年 9 月，我院对 382 例急性冠状动脉综合征（不稳定型心绞痛和非 ST 段抬高型心肌梗死）和 851 例稳定型心绞痛患者进行了首次孤立性冠状动脉旁路移植术。比较两组患者的早期和长期结果。
急性冠状动脉综合征患者年龄较大，女性较多，体表面积较小，左主干冠状动脉病变较多。两组患者双侧内乳动脉桥的使用率约为 89%，非体外循环技术的使用率约为 97%。急性冠状动脉综合征组的手术死亡率（2.6%比 0.1%）和低心排血量综合征（3.1%比 1.2%）及需要血液透析的发生率（2.9%比 1.1%）较高。多因素回归分析表明，年龄、急性冠状动脉综合征、射血分数较低和术前肌酐水平较高是手术死亡的独立预测因素。然而，在住院存活者中，急性冠状动脉综合征组和稳定型心绞痛组在全因死亡率（85.4%±2.5%比 87.7%±2.0%）、心脏性死亡率（97.4%±0.9%比 96.5%±0.9%）和主要不良心脑血管事件发生率（78.0%±2.9%比 78.1%±2.3%）方面，7 年时无差异。
虽然急性冠状动脉综合征是冠状动脉旁路移植术后早期死亡的独立预测因素，但在度过早期术后阶段后，急性冠状动脉综合征患者与稳定型心绞痛患者的手术长期结果相似。
