Dayan Victor, Stanham Roberto, Soca Gerardo, Genta Fernando, Mariño Jorge, Lorenzo Alvaro
National Institute of Cardiac Surgery, Montevideo, Uruguay.
Asian Cardiovasc Thorac Ann. 2017 Jan;25(1):18-23. doi: 10.1177/0218492316680496. Epub 2016 Nov 14.
Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days ( n = 216), 4-7 days ( n = 109), and ≥8 days ( n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min (12% vs. 4% for creatinine clearance ≤and >60 mL min, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.
关于计划进行单纯主动脉和/或二尖瓣置换术的患者在冠状动脉造影后早期进行心脏手术的风险，相关数据有限。我们的目的是评估这些患者在冠状动脉造影后早期手术的风险。方法：我们回顾性分析了2006年至2014年期间1044例行单纯主动脉和/或二尖瓣置换术患者的数据。收集了基线、手术中和术后变量。根据冠状动脉造影与手术之间的间隔时间，将患者分为3组：≤3天（n = 216）、4 - 7天（n = 109）和≥8天（n = 719）。我们评估了医院死亡率和术后急性肾损伤。根据术前肌酐清除率进行亚组分析。结果：冠状动脉造影后≤3天接受手术的患者术后肌酐清除率（63.57±38.52 mL/min）低于冠状动脉造影后≥8天接受手术的患者（74.56±54.25 mL/min，p = 0.015）。当术前肌酐清除率≤60 mL/min时，冠状动脉造影后≤3天接受手术的患者医院死亡率更高（肌酐清除率≤60 mL/min和>60 mL/min的患者分别为12%和4%；p = 0.039）。医院死亡率的预测因素是纽约心脏协会分级和术后肌酐清除率。结论：术前肾功能下降且在冠状动脉造影后前3天内接受手术的患者医院死亡率更高。对于这一亚组患者延迟手术可能是一个好策略。
