Rojas Sebastian V, Trinh-Adams Mai Linh, Uribarri Aitor, Fleissner Felix, Iablonskii Pavel, Rojas-Hernandez Sara, Ricklefs Marcel, Martens Andreas, Rümke Stefan, Warnecke Gregor, Cebotari Serghei, Haverich Axel, Ismail Issam
Department of Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Department of Cardiology, Complejo Hospitalario de Navarra, Pamplona, Spain.
J Thorac Dis. 2019 Nov;11(11):4444-4452. doi: 10.21037/jtd.2019.11.08.
In non-ST-elevation myocardial infarction (NSTEMI) there is no consensus regarding optimal time point for coronary artery bypass grafting (CABG). Recent findings suggest that long-term outcomes are improved in early-revascularized NSTEMI patients. However, it has been stated that early surgery is associated to increased operative risk. In this study, we wanted to elucidate if early CABG in non-ST-elevation acute coronary syndrome can be performed safely.
We performed a monocentric-prospective observational study within a 2-year interval. A total of 217 consecutive patients (41 female, age 68.9±10.2, ES II 6.62±8.56) developed NSTEMI and underwent CABG. Patients were divided into two groups according to the time point of coronary artery bypass after symptom onset (group A: <72 h; group B: >72 h). Endpoints included 6-month mortality and incidence of MACE (death, stroke or re-infarction).
There were no differences regarding mortality between both groups (30 days: group A 2.4% . group B 3.7%; P=0.592; 6 months: 8.4% . 6.0%; P=0.487). Incidence of MACE in the 6-month follow-up was also similar in both groups (group A: 9.6% . 9.7%, P=0.982). Regression analysis revealed as independent risk factors for mortality in the entire cohort ES II OR 1.045 (95% CI: 1.004-1.088). ES II remained an independent prognostic factor in group A OR 1.043 (95% CI: 1.003-1.086) and group B OR 1.032 (95% CI: 1.001-1.063).
Early revascularized patients showed a higher level of illness. However, results of early CABG were comparable to those following delayed revascularization. Moreover, EuroSCORE II was determined as independent risk factors for mortality.
在非ST段抬高型心肌梗死（NSTEMI）中，关于冠状动脉旁路移植术（CABG）的最佳时间点尚无共识。最近的研究结果表明，早期血运重建的NSTEMI患者的长期预后有所改善。然而，有人指出早期手术与手术风险增加有关。在本研究中，我们想阐明非ST段抬高型急性冠状动脉综合征患者早期进行CABG是否安全。
我们在2年的时间间隔内进行了一项单中心前瞻性观察研究。共有217例连续患者（41例女性，年龄68.9±10.2，欧洲心脏手术风险评估系统（EuroSCORE）II评分为6.62±8.56）发生NSTEMI并接受了CABG。根据症状发作后冠状动脉旁路移植的时间点将患者分为两组（A组：<72小时；B组：>72小时）。终点包括6个月死亡率和主要不良心血管事件（MACE，死亡、中风或再梗死）的发生率。
两组之间的死亡率无差异（30天：A组2.4%，B组3.7%；P=0.592；6个月：8.4%，6.0%；P=0.487）。两组在6个月随访中的MACE发生率也相似（A组：9.6%，9.7%，P=0.982）。回归分析显示，在整个队列中，欧洲心脏手术风险评估系统II评分为死亡率的独立危险因素，比值比（OR）为1.045（95%置信区间：1.004-1.088）。在A组中，欧洲心脏手术风险评估系统II评分仍然是独立的预后因素，OR为1.043（95%置信区间：1.003-1.086），在B组中，OR为1.032（95%置信区间：1.001-1.063）。
早期血运重建的患者病情较重。然而，早期CABG的结果与延迟血运重建后的结果相当。此外，欧洲心脏手术风险评估系统II评分被确定为死亡率的独立危险因素。
