Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Portugal.
Faculdade de Medicina, Universidade de Coimbra, Portugal.
Eur Heart J Acute Cardiovasc Care. 2020 Oct;9(7):731-740. doi: 10.1177/2048872619899309. Epub 2020 Mar 17.
Among patients presenting with an acute coronary syndrome, those with previous coronary artery bypass grafting are a particular subset.
The purpose of this study was to investigate the prognostic impact of previous coronary artery bypass grafting in acute coronary syndrome patients and to identify the current trends in their clinical management.
We performed a cohort analysis of patients prospectively enrolled in the Portuguese Registry of acute coronary syndrome between 2010-2019 with known previous coronary artery bypass grafting status. The co-primary endpoints were in-hospital and one-year mortality.
A total of 19,334 (962 coronary artery bypass grafting and 18,372 non-coronary artery bypass grafting) and 9402 (479 coronary artery bypass grafting and 8923 non-coronary artery bypass grafting) patients were included in the analyses of in-hospital and mid-term outcomes, respectively. Coronary artery bypass grafting patients were older and had a higher incidence of comorbidities. They were less likely to undergo invasive angiography (74.9 vs 84.6%, <0.001), but were equally likely to receive dual antiplatelet therapy (91.0 vs 90.8%, =0.823). In-hospital mortality was similar between groups (3.6 vs 3.4%, =0.722). Unadjusted one-year mortality was higher in the coronary artery bypass grafting group (hazard ratio 1.48, 95% confidence interval 1.09-2.01, =0.012), but similar in both groups after propensity-matching and multivariate analysis (hazard ratio 0.63, 95% confidence interval 0.37-1.09, =0.098).
Among patients with acute coronary syndrome, a previous history of coronary artery bypass grafting was associated with a high burden of comorbidities and a high-risk profile but was not an independent predictor of adverse events. Treatment decisions should be made on a case-by-case basis, and should not be based on previous coronary artery bypass grafting status alone.
在出现急性冠状动脉综合征的患者中，既往接受过冠状动脉旁路移植术的患者是一个特殊亚组。
本研究旨在探讨既往冠状动脉旁路移植术对急性冠状动脉综合征患者预后的影响，并确定目前其临床管理的趋势。
我们对 2010 年至 2019 年期间前瞻性纳入葡萄牙急性冠状动脉综合征注册登记研究的已知既往有冠状动脉旁路移植术的患者进行了队列分析。主要终点为院内和 1 年死亡率。
共有 19334 例（冠状动脉旁路移植术 962 例，非冠状动脉旁路移植术 18372 例）和 9402 例（冠状动脉旁路移植术 479 例，非冠状动脉旁路移植术 8923 例）患者分别纳入院内和中期结局分析。冠状动脉旁路移植术患者年龄较大，合并症发生率较高。他们接受血管造影的可能性较小（74.9%比 84.6%，<0.001），但接受双联抗血小板治疗的可能性相似（91.0%比 90.8%，=0.823）。两组院内死亡率相似（3.6%比 3.4%，=0.722）。未校正的 1 年死亡率在冠状动脉旁路移植术组较高（风险比 1.48，95%置信区间 1.09-2.01，=0.012），但在倾向匹配和多变量分析后两组相似（风险比 0.63，95%置信区间 0.37-1.09，=0.098）。
在急性冠状动脉综合征患者中，既往冠状动脉旁路移植术史与合并症负担重和高危特征相关，但不是不良事件的独立预测因素。治疗决策应根据具体情况做出，不应仅基于既往冠状动脉旁路移植术史。
