冠状动脉旁路移植术后院内经皮冠状动脉介入治疗的发生率、预测因素和结局。

Incidence, Predictors, and Outcomes of In-Hospital Percutaneous Coronary Intervention Following Coronary Artery Bypass Grafting.

机构信息

West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.

Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.

出版信息

J Am Coll Cardiol. 2019 Feb 5;73(4):415-423. doi: 10.1016/j.jacc.2018.10.071.

DOI:10.1016/j.jacc.2018.10.071

PMID:30704573

Abstract

BACKGROUND

Post-operative acute coronary ischemia is an uncommon complication of coronary artery bypass grafting (CABG). However, data on the incidence and outcomes of early coronary ischemia and in-hospital percutaneous coronary interventions (PCIs) after CABG are scarce.

OBJECTIVES

The aim of this study was to assess the incidence, predictors, and outcomes of early (in-hospital) PCI following CABG.

METHODS

This study utilized the National Inpatient Sample to select patients who underwent CABG between January 1, 2003, and December 31, 2014. Patients who had acute coronary ischemia requiring in-hospital PCI after CABG were compared with patients who did not need PCI. The primary endpoint was in-hospital mortality. Secondary endpoints were major complications, length-of-stay, and cost. Predictors of the need for post-CABG PCI were assessed in multivariate regression analyses.

RESULTS

Among the 554,987 studied patients, 24,503 (4.4%) had suspected acute coronary ischemia and underwent angiography post-operatively, of whom 14,323 had PCI. The majority (71.4%) of PCIs were performed within 24 h following CABG. Unadjusted in-hospital mortality was higher in patients who underwent PCI (5.1% vs. 2.7%; p < 0.001). The excess mortality persisted after multiple risk adjustments and sensitivity analyses. Patients who underwent post-CABG PCI had higher rates of strokes (2.1% vs. 1.6%; p < 0.001), acute kidney injury (16% vs. 12.3%; p < 0.001), and infectious complications. Post-CABG PCI was also associated with longer hospitalizations and a ∼50% increase in cost. Nonelective admissions and off-pump CABG were the strongest predictors of needing an in-hospital PCI following CABG.

CONCLUSIONS

In-hospital post-CABG PCI is uncommon but is associated with significantly increased morbidity, mortality, and cost. Further studies are needed to assess modifiable risk factors for early coronary compromise following CABG.

摘要

背景

术后急性冠状动脉缺血是冠状动脉旁路移植术（CABG）的一种罕见并发症。然而，关于 CABG 后早期冠状动脉缺血和院内经皮冠状动脉介入治疗（PCI）的发生率和结果的数据很少。

目的

本研究旨在评估 CABG 后早期（院内）PCI 的发生率、预测因素和结果。

方法

本研究利用国家住院患者样本选择 2003 年 1 月 1 日至 2014 年 12 月 31 日期间接受 CABG 的患者。将需要 CABG 后院内 PCI 的患者与不需要 PCI 的患者进行比较。主要终点是院内死亡率。次要终点是主要并发症、住院时间和费用。使用多变量回归分析评估 CABG 后需要 PCI 的预测因素。

结果

在 554987 名研究患者中，24503 名（4.4%）疑似急性冠状动脉缺血并在术后接受血管造影检查，其中 14323 名接受了 PCI。大多数（71.4%）的 PCI 是在 CABG 后 24 小时内进行的。未调整的院内死亡率在接受 PCI 的患者中更高（5.1%比 2.7%；p<0.001）。在多次风险调整和敏感性分析后，这种超额死亡率仍然存在。接受 CABG 后 PCI 的患者发生中风的比例更高（2.1%比 1.6%；p<0.001）、急性肾损伤（16%比 12.3%；p<0.001）和感染性并发症的发生率更高。CABG 后 PCI 还与住院时间延长和费用增加约 50%相关。非选择性入院和非体外循环 CABG 是 CABG 后需要院内 PCI 的最强预测因素。