Li Sen, Li Haiqing, Yuan Zhize, Zhang Baoli, Chen Anqing, Zhou Mi, Liu Jun, Cai Junfeng, Wang Zhe, Ye Xiaofeng, Zhao Qiang
Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
Interact Cardiovasc Thorac Surg. 2017 Aug 1;25(2):218-224. doi: 10.1093/icvts/ivx064.
The prognostic value of myocardial viability before coronary bypass grafting remains controversial. The present study evaluated the effects of off-pump coronary artery bypass (OPCAB) grafting on patients with coronary artery disease (CAD) with or without viable myocardium (VM) preoperatively detected via nuclear imaging.
A total of 115 consecutive patients with 3-vessel disease and impaired left ventricular ejection fraction (LVEF ≤ 45%) who underwent OPCAB grafting were recruited in this prospective study. The patients were divided into 2 groups based on myocardial viability, the non-viable myocardium (NVM, 55 patients) and VM (60 patients) groups. Positron emission tomography and radionuclide imaging examination were applied to evaluate the myocardium viability. A Kaplan-Meier analysis was conducted to evaluate the 1-year survival rate.
The preoperative data were similar between groups. An improvement in the LVEF was observed in both groups 12 months after OPCAB grafting (P < 0.05). A binary logistic regression revealed that NVM was an independent predictor of a 5% improvement in LVEF at 6 months (P = 0.012). The rate of main adverse cardiovascular and cerebrovascular events (MACCEs) rate at 1 year was similar between the 2 groups (P = 0.06). At 1 year, the death rates were 14.5% in the NVM group and 5% in the VM group (P = 0.17). A Cox regression analysis revealed that NVM and age were independent predictors of mortality [the hazard ratio for death associated with NVM and age were 1.62, 95% confidence interval (CI) = 1.16-2.89, P = 0.036 and 1.05, 95% CI = 0.98-1.12, P =0.025, respectively].
The MACCEs and mortality rates of the NVM group were higher than those of the VM group. However, OPCAB surgery improved LVEF, regardless of myocardium status. Therefore, the assessment of myocardial viability might not be the sole deciding factor in decision-making process regarding OPCAB surgery.
冠状动脉搭桥术前心肌存活性的预后价值仍存在争议。本研究评估了非体外循环冠状动脉搭桥术（OPCAB）对术前经核成像检测存在或不存在存活心肌（VM）的冠心病（CAD）患者的影响。
本前瞻性研究共纳入115例接受OPCAB手术的三支血管病变且左心室射血分数受损（LVEF≤45%）的连续患者。根据心肌存活性将患者分为两组，即无存活心肌（NVM，55例患者）组和VM（60例患者）组。应用正电子发射断层扫描和放射性核素成像检查评估心肌存活性。采用Kaplan-Meier分析评估1年生存率。
两组术前数据相似。OPCAB术后12个月，两组LVEF均有改善（P<0.05）。二元逻辑回归显示，NVM是6个月时LVEF改善5%的独立预测因素（P=0.012）。两组1年时主要心血管和脑血管不良事件（MACCEs）发生率相似（P=0.06）。1年时，NVM组死亡率为14.5%，VM组为5%（P=0.17）。Cox回归分析显示，NVM和年龄是死亡率的独立预测因素[与NVM和年龄相关的死亡风险比分别为1.62，95%置信区间（CI）=1.16-2.89，P=0.036和1.05，95%CI=0.98-1.12，P=0.025]。
NVM组的MACCEs和死亡率高于VM组。然而，无论心肌状态如何，OPCAB手术均可改善LVEF。因此，心肌存活性评估可能不是OPCAB手术决策过程中的唯一决定因素。
