Naunheim K S, Fiore A C, Fagan D C, McBride L R, Barner H B, Pennington D G, Willman V L, Kern M J, Deligonul U, Vandormael M C
Division of Cardiothoracic Surgery, St. Louis University Medical Center, Missouri 63110-0250.
Ann Thorac Surg. 1989 Jun;47(6):816-22; discussion 822-3. doi: 10.1016/0003-4975(89)90010-6.
It has been suggested that coronary artery bypass grafting (CABG) performed in the setting of emergent failure of percutaneous transluminal coronary angioplasty causes minimal increased risk compared with routine CABG. We reviewed the records of 103 patients undergoing emergency CABG for failed percutaneous transluminal coronary angioplasty (group 1) and compared them with an identical number of consecutive CABG patients from 1987 (group 2). Group 1 had a lower risk profile evidenced by lower mean age (p less than 0.01), fewer diseased vessels (p less than 0.0001), better ventricular function (p less than 0.001), fewer left main lesions (p less than 0.0001), and fewer patients with acute ischemia requiring intravenous administration of nitroglycerin (p less than 0.01). Despite these differences, the group 1 patients had a higher mortality rate (11% versus 1%; p less than 0.01) and a higher rate of perioperative infarctions (new Q wave) (22% versus 6%; p less than 0.01). An analysis of risk factors was performed in the group 1 patients using 36 preoperative and operative variables. Multivariate analysis revealed that left ventricular score (p less than 0.0001), preoperative (after percutaneous transluminal coronary angioplasty) need for inotropic support (p less than 0.005), and age (p less than 0.025) were independent predictors of operative mortality. In conclusion, emergency CABG after failed percutaneous transluminal coronary angioplasty carries a significantly greater risk of operative death and perioperative infarction than elective CABG.
有人提出，在经皮腔内冠状动脉成形术紧急失败的情况下进行冠状动脉旁路移植术（CABG）与常规CABG相比，增加的风险最小。我们回顾了103例因经皮腔内冠状动脉成形术失败而接受急诊CABG的患者（第1组）的记录，并将其与1987年相同数量的连续CABG患者（第2组）进行比较。第1组的风险特征较低，表现为平均年龄较低（p<0.01）、病变血管较少（p<0.0001）、心室功能较好（p<0.001）、左主干病变较少（p<0.0001）以及需要静脉注射硝酸甘油的急性缺血患者较少（p<0.01）。尽管存在这些差异，第1组患者的死亡率较高（11%对1%；p<0.01），围手术期梗死率（新Q波）也较高（22%对6%；p<0.01）。使用36个术前和手术变量对第1组患者进行了危险因素分析。多变量分析显示，左心室评分（p<0.0001）、术前（经皮腔内冠状动脉成形术后）对正性肌力支持的需求（p<0.005）和年龄（p<0.025）是手术死亡率的独立预测因素。总之，经皮腔内冠状动脉成形术失败后进行急诊CABG的手术死亡和围手术期梗死风险明显高于择期CABG。
