Dayan Victor, Perez Diego, Silva Eloisa, Soca Gerardo, Estigarribia Jorge
Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay.
Braz J Cardiovasc Surg. 2018 Jan-Feb;33(1):47-53. doi: 10.21470/1678-9741-2017-0138.
In contrast to unstable angina, optimal therapy in patients with stable angina is debated. Our aim was to evaluate the outcomes of patients with stable angina scheduled for isolated coronary artery bypass grafts and the effect of preoperative use of beta-blockers. Overall and cardiovascular survivals were our primary outcome. Operative mortality and postoperative complications along with subgroup analysis of diabetic patients were our secondary outcomes.
Retrospective evaluation of patients with stable angina scheduled for isolated coronary artery bypass grafts was included. Pre- and postoperative variables were extracted from the institution database. Survival was obtained from the National Registry.
We included 282 patients with stable angina, with a mean age of 65.6±9.5 years. 26.6% were female and 38.7% had diabetes. Three-vessel disease was present in 76.6% of patients. Previous beta-blocker treatment was evident in 69.9% of patients. 10-year overall survival in the whole population was 60.5% (95% confidence interval [CI]: 50.3-70.7%). Operative mortality during the study period was 3.5%. Patients with preoperative use of beta-blocker therapy had better overall survival (9.0 years, 95%CI: 8.6-9.5) than those without treatment (7.9 years, 95%CI: 7.1-8.8 years; P=0.048). Predictors for overall survival were: hypertension, diabetes, and age. Predictors for cardiovascular survival in diabetic patients were: beta-blocker use, gender, and age.
Coronary artery bypass grafts surgery in patients with stable angina carries low operative mortality, postoperative complications, and excellent long-term cardiovascular survival. The preoperative use of beta-blockers in diabetic patients is associated with better cardiovascular survival after coronary artery bypass grafts.
与不稳定型心绞痛不同，稳定型心绞痛患者的最佳治疗方法存在争议。我们的目的是评估计划进行单纯冠状动脉搭桥术的稳定型心绞痛患者的预后以及术前使用β受体阻滞剂的效果。总体生存率和心血管生存率是我们的主要结局指标。手术死亡率、术后并发症以及糖尿病患者的亚组分析是我们的次要结局指标。
纳入对计划进行单纯冠状动脉搭桥术的稳定型心绞痛患者的回顾性评估。术前和术后变量从机构数据库中提取。生存率从国家登记处获得。
我们纳入了282例稳定型心绞痛患者，平均年龄为65.6±9.5岁。26.6%为女性，38.7%患有糖尿病。76.6%的患者存在三支血管病变。69.9%的患者曾接受过β受体阻滞剂治疗。整个人群的10年总体生存率为60.5%（95%置信区间[CI]：50.3 - 70.7%）。研究期间的手术死亡率为3.5%。术前使用β受体阻滞剂治疗的患者总体生存率更好（9.0年，95%CI：8.6 - 9.5），优于未接受治疗的患者（7.9年，95%CI：7.1 - 8.8年；P = 0.048）。总体生存的预测因素为：高血压、糖尿病和年龄。糖尿病患者心血管生存的预测因素为：β受体阻滞剂的使用、性别和年龄。
稳定型心绞痛患者进行冠状动脉搭桥手术的手术死亡率低、术后并发症少，且长期心血管生存率良好。糖尿病患者术前使用β受体阻滞剂与冠状动脉搭桥术后更好的心血管生存相关。
