非ST段抬高型心肌梗死患者早期与延迟冠状动脉旁路移植手术

Early versus delayed coronary artery bypass graft surgery for patients with non-ST elevation myocardial infarction.

作者信息

Ha Le Dung, Ogunbayo Gbolahan, Elbadawi Ayman, Olorunfemi Odunayo, Messerli Adrian

机构信息

aDepartment of Internal Medicine, Rochester General Hospital, Rochester, New York bUniversity of Kentucky, Lexington, Kentucky, USA.

出版信息

Coron Artery Dis. 2017 Dec;28(8):670-674. doi: 10.1097/MCA.0000000000000537.

DOI:10.1097/MCA.0000000000000537

PMID:28723830

Abstract

BACKGROUND

Although coronary artery bypass graft surgery (CABG) has been proven to have mortality and morbidity benefits in patients with non-ST elevation myocardial infarction and multivessel disease, the appropriate timing of this procedure remains unclear. Therefore, we proposed a propensity score-matched analysis comparing the clinical outcomes between patients who underwent CABG within the first 48 h of admission (early CABG) and patients who underwent CABG after 48 h of admission (delayed CABG).

PATIENTS AND METHODS

Using the largest inpatient care database in the USA, the Nationwide Inpatient Sample, we identified patients with a primary diagnosis of acute myocardial infarction using the ICD 9-DM diagnosis codes. We then performed propensity score-matching analysis to control for 24 possible confounders.

RESULTS

We identified 31 969 patients in the Nationwide Inpatient Sample database with a primary diagnosis of acute myocardial infarction who underwent CABG. The mean age of the cohort was 64.5±11.5 years and 33.4% were female. After performing propensity-matching analysis, we obtained a subset of 1555 patients in each group, with a mean age of 64.7±10.1 years; the male to female ratio was ~4 : 1. The incidence of hemorrhage, shock, and cardiac, pulmonary, and renal complications was comparable between the two groups. The incidence of mortality was not statistically significant between the two groups (2% in the early CABG vs. 1.8% in the delayed CABG, P=0.695). The mortality risk factors were as follows: age more than 70 years [odds ratio (OR): 3.42, 95% confidence interval (CI): 1.85-6.34, P<0.001]; cardiogenic shock (OR: 3.22, 95% CI: 1.35-7.67, P=0.008); and mechanical circulatory support with balloon counterpulsation (OR: 2.93, 95% CI: 1.45-5.90, P=0.003).

CONCLUSION

CABG performed within 48 h of admission does not significantly increase the risk for in-hospital mortality compared with undergoing the procedure after 48 h of admission in propensity-matched patients.

摘要

背景

尽管冠状动脉搭桥手术（CABG）已被证明对非ST段抬高型心肌梗死和多支血管病变患者有降低死亡率和发病率的益处，但该手术的合适时机仍不明确。因此，我们进行了一项倾向评分匹配分析，比较入院后48小时内接受CABG的患者（早期CABG）和入院48小时后接受CABG的患者（延迟CABG）的临床结局。

患者和方法

我们使用美国最大的住院患者护理数据库全国住院样本，通过ICD 9-DM诊断代码识别出原发性诊断为急性心肌梗死的患者。然后进行倾向评分匹配分析，以控制24种可能的混杂因素。

结果

我们在全国住院样本数据库中识别出31969例原发性诊断为急性心肌梗死且接受CABG的患者。该队列的平均年龄为64.5±11.5岁，33.4%为女性。进行倾向匹配分析后，我们在每组中获得了一个包含1555例患者的子集，平均年龄为64.7±10.1岁；男女比例约为4∶1。两组之间出血、休克以及心脏、肺部和肾脏并发症的发生率相当。两组之间的死亡率无统计学差异（早期CABG组为2%，延迟CABG组为1.8%，P = 0.695）。死亡风险因素如下：年龄超过70岁[比值比（OR）：3.42，95%置信区间（CI）：1.85 - 6.34，P < 0.001]；心源性休克（OR：3.22，95% CI：1.35 - 7.67，P = 0.008）；以及使用球囊反搏的机械循环支持（OR：2.93，95% CI：1.45 - 5.90，P = 0.003）。