在接受外科冠状动脉血运重建术的急性心肌梗死且无心源性休克的患者中术前置入主动脉内球囊泵。

Preoperative intra-aortic balloon pump inserted in acute myocardial infarction patients without cardiogenic shock undergoing surgical coronary revascularization.

机构信息

Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

出版信息

Perfusion. 2020 Mar;35(2):145-153. doi: 10.1177/0267659119865834. Epub 2019 Aug 7.

DOI:10.1177/0267659119865834

PMID:31387455

Abstract

OBJECTIVES

The benefit of preoperative intra-aortic balloon pump implantation in high-risk cardiac surgery patients is still debated. The role of preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting remains unknown. This study aimed to determine the efficacy and safety of the preoperative intra-aortic balloon pump insertion in those patients undergoing off-pump coronary artery bypass grafting.

METHODS

A total of 421 consecutive acute myocardial infarction patients without cardiogenic shock who underwent isolated off-pump coronary artery bypass grafting were enrolled in this retrospective observational propensity score-matched analysis study. Patients who received intra-aortic balloon pump before off-pump coronary artery bypass grafting (the intra-aortic balloon pump group, n = 157) were compared with those who had not (control group, n = 264). The 30-day postoperative survival, postoperative complications, and postoperative hospital length of stay were compared between the two groups.

RESULTS

A total of 99 pairs of patients were matched. The preoperative intra-aortic balloon pump did not show a 30-day postoperative survival benefit compared with the control group (hazard ratio, 0.9; 95% confidence interval, 0.2-4.2; p = 0.92). Patients with preoperative intra-aortic balloon pump were more likely to have shorter postoperative lengths of stay (8 (6-11) days vs. 10 (6-15) days, p = 0.02) and decreased total days in the hospital (median days: 18.2 vs. 21.8, p = 0.02) compared to patients without balloon pumps.

CONCLUSION

Preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting improved convalescence as shown by significantly shorter postoperative lengths of hospital stay.

摘要

目的

术前主动脉内球囊泵植入在高危心脏手术患者中的益处仍存在争议。在无心源性休克的急性心肌梗死患者中行不停跳冠状动脉旁路移植术时，术前主动脉内球囊泵插入的作用尚不清楚。本研究旨在确定在这些行不停跳冠状动脉旁路移植术的患者中术前主动脉内球囊泵插入的疗效和安全性。

方法

本回顾性观察倾向评分匹配分析研究共纳入 421 例连续的无心源性休克的急性心肌梗死患者，这些患者均行单纯不停跳冠状动脉旁路移植术。接受术前主动脉内球囊泵治疗的患者（主动脉内球囊泵组，n=157）与未接受治疗的患者（对照组，n=264）进行比较。比较两组患者的 30 天术后存活率、术后并发症和术后住院时间。

结果

共匹配了 99 对患者。与对照组相比，术前主动脉内球囊泵并未显示出 30 天术后存活率的优势（风险比，0.9；95%置信区间，0.2-4.2；p=0.92）。与未使用球囊泵的患者相比，使用术前主动脉内球囊泵的患者术后住院时间更短（8（6-11）天比 10（6-15）天，p=0.02），总住院天数减少（中位数：18.2 天比 21.8 天，p=0.02）。