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既往冠状动脉支架置入术不会增加非体外循环冠状动脉旁路移植术患者的早期和长期不良结局:一项倾向评分匹配比较。

Previous coronary stents do not increase early and long-term adverse outcomes in patients undergoing off-pump coronary artery bypass grafting: a propensity-matched comparison.

作者信息

Fukui Toshihiro, Tanaka Sachiko, Takanashi Shuichiro

机构信息

Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.

EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.

出版信息

J Thorac Cardiovasc Surg. 2014 Nov;148(5):1843-9. doi: 10.1016/j.jtcvs.2014.02.004. Epub 2014 Feb 12.

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

Previous coronary stents do not increase early and long-term morbidity or mortality in patients undergoing off-pump CABG.

摘要

目的

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。

方法

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。

结果

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)。

结论

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。

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