Wang Rong, Cheng Nan, Xiao Cang-Song, Wu Yang, Sai Xiao-Yong, Gong Zhi-Yun, Wang Yao, Gao Chang-Qing
Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Institute of Geriatrics, People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2017 Feb 20;130(4):392-397. doi: 10.4103/0366-6999.199847.
The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction (STEMI) and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction (LVD) by comparing early and late results.
From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting (CABG) in our institution. Two hundred and sixty-four (223 male, 41 females) patients with a history of STEMI and LVD were divided into early revascularization (ER, <3 weeks), mid-term revascularization (MR, 3 weeks to 3 months), and late revascularization (LR, >3 months) groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher's exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival.
No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups (P > 0.05). More patients in the ER group (12.90%) had low cardiac output syndrome than those in the MR (2.89%) and LR (3.05%) groups (P = 0.035). The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively (P = 0.716). Cox regression analyses showed a severe preoperative condition (odds ratio = 7.13, 95% confidence interval 2.05-24.74, P = 0.002) rather than the time interval of CABG (P > 0.05) after myocardial infarction was a risk factor of long-term survival.
Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER (<3 weeks) has a higher incidence of postoperative low cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival.
ST段抬高型心肌梗死（STEMI）伴左心室功能受损患者手术血运重建的最佳时机尚未明确。本研究旨在通过比较早期和晚期结果，探讨缺血性心脏病伴左心室功能障碍（LVD）的STEMI患者在STEMI后进行手术血运重建的时机。
2003年1月至2013年12月，我院有2276例患者接受单纯冠状动脉旁路移植术（CABG）。264例（223例男性，41例女性）有STEMI和LVD病史的患者根据从STEMI到CABG的时间间隔分为早期血运重建组（ER，<3周）、中期血运重建组（MR，3周~3个月）和晚期血运重建组（LR，>3个月）。采用Fisher精确检验比较各组的死亡率和并发症发生率。进行Cox回归分析以检验手术时间间隔对长期生存的影响。
各组间30天死亡率、长期生存、全因死亡自由率和因心力衰竭再住院率无显著差异（P>0.05）。ER组（12.90%）低心排血量综合征患者多于MR组（2.89%）和LR组（3.05%）（P=0.035）。平均随访时间分别为46.72±30.65、48.70±32.74和43.75±32.43个月（P=0.716）。Cox回归分析显示，术前病情严重（比值比=7.13，95%置信区间2.05~24.74，P=0.002）而非心肌梗死后CABG的时间间隔（P>0.05）是长期生存的危险因素。
STEMI和LVD患者的手术血运重建可在STEMI后的不同时间进行，手术死亡率和长期生存率相当。然而，ER组（<3周）术后低心排血量综合征的发生率较高。术前病情严重而非STEMI后CABG的时间间隔是长期生存的危险因素。
