Fukui Toshihiro, Tanaka Sachiko, Takanashi Shuichiro
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):1843-9. doi: 10.1016/j.jtcvs.2014.02.004. Epub 2014 Feb 12.
The aim of our study was to compare the early and long-term outcomes of patients undergoing off-pump coronary artery bypass grafting (CABG) with and without previous coronary stents.
Between September 2004 and September 2011, 269 patients with previous stents underwent first-time isolated off-pump CABG. These patients were compared with 897 patients without previous stent. A propensity score-matching analysis was performed to compare early and late outcomes between the groups. Mean follow-up time was 43.4 months after surgery.
Patients with previous stents were more likely to be men (85.9% in the stent group vs 79.4% in the no-stent group; P=.022) and more likely to have prior myocardial infarction (60.2% vs 36.8%; P<.001). Mean number of anastomoses was lower in patients with previous stents than in patients without previous stents (4.0 vs 4.2; P=.037). There was no difference in the use of bilateral internal thoracic artery graft between the groups (88.8% vs 89.1%; P>.999). After propensity adjustment for preoperative characteristics, both operative death (0.7% vs 1.5%; P=.414) and the major complications rates (7.8% vs 7.5%; P=.869) were similar between the groups. The actuarial survival rate at 7 years was not different between the groups (87.2%±3.2% vs 84.8%±2.9%; P=.470). Furthermore, freedom from major adverse cardiac and cerebrovascular events at 7 years were similar between the groups (78.9%±3.8% vs 77.6%±3.3%; P=.811).
Previous coronary stents do not increase early and long-term morbidity or mortality in patients undergoing off-pump CABG.
我们研究的目的是比较接受非体外循环冠状动脉旁路移植术（CABG）的患者，有或没有冠状动脉支架植入史的早期和长期结果。
在2004年9月至2011年9月期间，269例有支架植入史的患者首次接受非体外循环CABG。这些患者与897例无支架植入史的患者进行比较。进行倾向得分匹配分析以比较两组之间的早期和晚期结果。术后平均随访时间为43.4个月。
有支架植入史的患者男性比例更高（支架组为85.9%，无支架组为79.4%；P = 0.022），且更有可能有既往心肌梗死病史（60.2%对36.8%；P < 0.001）。有支架植入史的患者平均吻合口数量低于无支架植入史的患者（4.0对4.2；P = 0.037）。两组之间双侧胸廓内动脉移植的使用情况无差异（88.8%对89.1%；P > 0.999）。在对术前特征进行倾向调整后，两组之间的手术死亡率（0.7%对1.5%；P = 0.414）和主要并发症发生率（7.8%对7.5%；P = 0.869）相似。两组7年的精算生存率无差异（87.2%±3.2%对84.8%±2.9%；P = 0.470）。此外，两组7年时无重大不良心脑血管事件的发生率相似（78.9%±3.8%对77.6%±3.3%；P = 0.811）。
既往冠状动脉支架植入史不会增加接受非体外循环CABG患者的早期和长期发病率或死亡率。
