Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Surg Res. 2013 Nov;185(1):166-73. doi: 10.1016/j.jss.2013.05.042. Epub 2013 Jun 3.
We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting.
Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo.
In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62-4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71-16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02-4.08; P = 0.045).
CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.
我们评估了非体外循环冠状动脉旁路移植术后不完全血运重建（IR）对长期预后的影响。
在连续接受非体外循环冠状动脉旁路移植术的 1553 例三血管疾病患者中，1351 例（87.0%）行完全血运重建（CR），202 例行 IR（13.0%）。经倾向评分患者匹配后，每组各有 200 例患者。在患者匹配前后评估心脏生存率和主要不良心脏和脑血管事件（MACCE）。进行亚组分析以评估左心室射血分数（LVEF）与血运重建完全性之间的相互作用。随访时间为 60 个月。
在全患者分析中，CR 组院内死亡率、心脏死亡率和 MACCE 的发生率较低（P=0.033、P<0.001 和 P=0.003）。CR 组 5 年心脏生存率为 96.5%±0.6%，IR 组为 88.9%±2.5%（P<0.001），MACCE 无事件率分别为 85.4%±1.2%和 78.8%±3.4%（P=0.015）。患者匹配后，CR 组 5 年心脏生存率优于 IR 组（96.2%±1.4%与 88.8%±2.5%，P=0.022），MACCE 无事件率相似。IR 是心脏死亡的独立预测因子（风险比 2.76，95%置信区间 1.62-4.70；P<0.001）。IR 在 LVEF 较低的患者中预测心脏死亡更为明显（风险比 5.29，95%置信区间 1.71-16.39；P=0.004），而在 LVEF 正常的患者中预测心脏死亡不明显（风险比 2.04，95%置信区间 1.02-4.08；P=0.045）。
与 IR 相比，非体外循环冠状动脉旁路移植术后 CR 与 5 年随访后的心脏生存率提高有关。在 LVEF 较低的患者中，CR 的获益更为显著。应尽可能实现 CR，尤其是在 LVEF 较低的患者中。
