Unità di Cure Intensive Cardiologiche, De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
Am J Cardiol. 2020 Jun 15;125(12):1788-1793. doi: 10.1016/j.amjcard.2020.03.021. Epub 2020 Apr 2.
The prognostic role of previous coronary artery bypass (CABG) in elderly patients admitted to hospital for an acute coronary syndrome (ACS) is unclear. Therefore, the aim of this study was to compare the prognosis of patients aged ≥75 years admitted for an ACS with or without previous history of CABG. The primary outcome of the study was a composite of overall mortality, recurrent nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 1-year follow-up. We included 2,253 ACS patients, aged 81 (78 to 85) years enrolled in 3 multicenter studies (the Italian Elderly ACS study, the LADIES ACS study, and the Elderly ACS 2 randomised trial) - 178 (7.9%) with previous CABG, 2,075 (92.1%) without. Patients with previous CABG had a higher burden of cardiovascular risk factors, lower ejection fraction, and higher creatinine values on admission. However, both at univariate analysis and after adjustment for the most relevant covariates (sex, age, previous myocardial infarction, type of ACS, left ventricular ejection fraction, and serum creatinine on admission), previous CABG did not show any statistically significant association with 1-year outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.61 to 1.19; p = 0.353). In conclusion, our study suggests that elderly ACS patients with previous CABG have worse basal clinical characteristics. Nevertheless, in a broad cohort of patients mostly treated with percutaneous coronary intervention during the index event, previous CABG did not confer independent additional risk of major adverse cardiovascular events at 1-year follow-up.
先前接受冠状动脉旁路移植术（CABG）的老年患者因急性冠状动脉综合征（ACS）住院的预后作用尚不清楚。因此，本研究旨在比较有或无先前 CABG 病史的年龄≥75 岁 ACS 患者的预后。该研究的主要结局是 1 年随访时全因死亡率、复发性非致死性心肌梗死、非致死性卒中和心力衰竭再住院的复合终点。我们纳入了 3 项多中心研究（意大利老年 ACS 研究、LADIES ACS 研究和老年 ACS2 随机试验）中的 2253 例年龄为 81（78 至 85）岁的 ACS 患者，其中 178 例（7.9%）有先前的 CABG，2075 例（92.1%）无。先前有 CABG 的患者心血管危险因素负担较高，入院时射血分数较低，肌酐值较高。然而，无论是在单变量分析还是在调整了最相关的协变量（性别、年龄、先前的心肌梗死、ACS 类型、左心室射血分数和入院时的血清肌酐）后，先前的 CABG 与 1 年的结局均无统计学显著关联（调整后的风险比为 0.85；95%置信区间为 0.61 至 1.19；p=0.353）。总之，我们的研究表明，先前接受过 CABG 的老年 ACS 患者的基础临床特征较差。然而，在主要接受经皮冠状动脉介入治疗的广泛患者队列中，先前的 CABG 在 1 年随访时并未带来主要不良心血管事件的独立额外风险。
