糖尿病患者冠状动脉搭桥术中使用单根胸廓内动脉加桡动脉搭桥与双侧胸廓内动脉搭桥的相似结局。
Similar Outcomes in Diabetes Patients After Coronary Artery Bypass Grafting With Single Internal Thoracic Artery Plus Radial Artery Grafting and Bilateral Internal Thoracic Artery Grafting.
作者信息
Raza Sajjad, Blackstone Eugene H, Houghtaling Penny L, Koprivanac Marijan, Ravichandren Kirthi, Javadikasgari Hoda, Bakaeen Faisal G, Svensson Lars G, Sabik Joseph F
机构信息
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
Ann Thorac Surg. 2017 Dec;104(6):1923-1932. doi: 10.1016/j.athoracsur.2017.05.050. Epub 2017 Aug 18.
BACKGROUND
The purpose of this study was to determine in patients with diabetes mellitus whether single internal thoracic artery (SITA) plus radial artery (RA) grafting yields outcomes similar to those of bilateral internal thoracic artery (BITA) grafting.
METHODS
From January 1994 to January 2011, 1,325 diabetic patients underwent primary isolated coronary artery bypass graft surgery with either (1) SITA plus RA with or without saphenous vein (SV) grafts (n = 965) or (2) BITA with or without SV grafts (n = 360); an internal thoracic artery was used in all patients to graft the left anterior descending coronary artery. Endpoints were in-hospital outcomes and time-related mortality. Median follow-up was 7.4 years, with a total follow-up of 9,162 patient-years. Propensity score matching was performed to identify 282 well-matched pairs for adjusted comparisons.
RESULTS
Unadjusted in-hospital mortality was 0.52% for SITA plus RA with or without SV grafts and 0.28% for BITA with or without SV grafts, and prevalence of deep sternal wound infection was 3.2% and 1.7%, respectively. Unadjusted survival at 1, 5, 10, and 14 years was 97%, 88%, 68%, and 51% for SITA plus RA with or without SV grafts, and 97%, 95%, 80%, and 66% for BITA with or without SV grafts, respectively. Among propensity-matched patients, in-hospital mortality (0.35% versus 0.35%) and prevalence of deep sternal wound infection (1.4% versus 1.4%) were similar (p > 0.9) in the two groups, as was 1-, 5-, 10-, and 14-year survival: 97%, 90%, 70%, and 58% for SITA plus RA with or without SV grafting versus 97%, 93%, 79%, and 64% for BITA with or without SV grafting, respectively (early p = 0.8, late p = 0.2).
CONCLUSIONS
For diabetic patients, SITA plus RA with or without SV grafting and BITA with or without SV grafting yield similar in-hospital outcomes and long-term survival after coronary artery bypass graft surgery. Therefore, both SITA plus RA and BITA plus SV grafting should be considered for these patients.
背景
本研究旨在确定在糖尿病患者中，单支胸廓内动脉（SITA）加桡动脉（RA）搭桥术的效果是否与双侧胸廓内动脉（BITA）搭桥术相似。
方法
从1994年1月至2011年1月，1325例糖尿病患者接受了初次单纯冠状动脉旁路移植手术，其中（1）SITA加RA，伴或不伴大隐静脉（SV）移植（n = 965），或（2）BITA，伴或不伴SV移植（n = 360）；所有患者均使用胸廓内动脉移植至左前降支冠状动脉。观察终点为住院结局和与时间相关的死亡率。中位随访时间为7.4年，总随访时间为9162患者年。进行倾向评分匹配以识别282对匹配良好的配对进行调整后的比较。
结果
伴或不伴SV移植的SITA加RA组的未调整住院死亡率为0.52%，伴或不伴SV移植的BITA组为0.28%，深部胸骨伤口感染的发生率分别为3.2%和1.7%。伴或不伴SV移植的SITA加RA组在1年、5年、10年和14年的未调整生存率分别为97%、88%、68%和51%，伴或不伴SV移植的BITA组分别为97%、95%、80%和66%。在倾向评分匹配的患者中，两组的住院死亡率（0.35%对0.35%）和深部胸骨伤口感染的发生率（1.4%对1.4%）相似（p>0.9），1年、5年、10年和14年的生存率也相似：伴或不伴SV移植的SITA加RA组分别为97%、90%、70%和58%，伴或不伴SV移植的BITA组分别为97%、93%、79%和64%（早期p = 0.8，晚期p = 0.2）。
结论
对于糖尿病患者，伴或不伴SV移植的SITA加RA以及伴或不伴SV移植的BITA在冠状动脉旁路移植手术后的住院结局和长期生存率相似。因此，对于这些患者，应考虑SITA加RA和BITA加SV移植这两种术式。
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