Liakopoulos Oliver J, Slottosch Ingo, Wendt Daniel, Welp Hendryk, Schiller Wolfgang, Martens Sven, Choi Yeong-Hoon, Welz Armin, Pisarenko Julia, Neuhäuser Markus, Jakob Heinz, Ruhparwar Arjang, Wahlers Thorsten, Thielmann Matthias
Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1137-1144. doi: 10.1093/ejcts/ezaa260.
The aim of this was to analyse current outcomes in patients referred to coronary artery bypass grafting (CABG) for acute coronary syndromes (ACSs), including ST-elevation or non-ST-elevation ACS (non-ST-segment elevation myocardial infarction) or unstable angina.
Patients (n = 2432) undergoing CABG for ACS between January 2010 and December 2017 were prospectively entered into a surgical myocardial infarction registry in North Rhine-Westphalia, Germany. Key end points were in-hospital all-cause mortality (IHM) and major adverse cardio-cerebral events (MACCE). Predictors for IHM and MACCE were analysed by multivariable logistic regression.
Patients (78% males) were referred for CABG for unstable angina (25%), non-ST-segment elevation myocardial infarction (50%), and ST-segment elevation myocardial infarction (25%). The mean patient age was 68 ± 11 years, logistic EuroSCORE was 19 ± 18% and three-vessel and left main stem diseases were diagnosed in 81% and 45% of patients, respectively. On-pump CABG with cardiac arrest or beating heart was performed in 92% and 2%, respectively, with only 6% off-pump surgery and 6% multiple arterial revascularization (3.1 ± 1.0 grafts, 93% left internal thoracic artery). Emergency CABG was performed in 23% of patients (42% in ST-segment elevation myocardial infarction; P < 0.001). The total IHM and MACCE rates were 8.1% and 17.5% and were highest in ST-segment elevation myocardial infarction patients with 12.6% and 28.5%, respectively (P < 0.001). Key predictors for IHM and MACCE were female gender, elevated troponin, left ventricular ejection fraction, inotropic support, logistic EuroSCORE, cardiopulmonary bypass and aortic clamp time and the need for emergency CABG.
Surgical myocardial revascularization in patients with ACS is still linked to substantial in-hospital mortality. Emergency CABG for patients with ACS was associated with poorer outcomes.
本研究旨在分析因急性冠状动脉综合征（ACS）接受冠状动脉旁路移植术（CABG）患者的当前预后情况，ACS包括ST段抬高型或非ST段抬高型ACS（非ST段抬高型心肌梗死）或不稳定型心绞痛。
2010年1月至2017年12月期间因ACS接受CABG的患者（n = 2432）前瞻性纳入德国北莱茵 - 威斯特法伦州的外科心肌梗死登记处。主要终点是院内全因死亡率（IHM）和主要不良心脑血管事件（MACCE）。通过多变量逻辑回归分析IHM和MACCE的预测因素。
患者（78%为男性）因不稳定型心绞痛（25%）、非ST段抬高型心肌梗死（50%）和ST段抬高型心肌梗死（25%）接受CABG。患者平均年龄为68±11岁，逻辑欧洲心脏手术风险评估系统（EuroSCORE）为19±18%，81%和45%的患者分别诊断为三支血管病变和左主干病变。分别有92%和2%的患者接受了心脏停搏或不停跳的体外循环CABG，仅6%为非体外循环手术，6%为多支动脉血运重建（3.1±1.0支移植血管，93%为左内乳动脉）。23%的患者接受了急诊CABG（ST段抬高型心肌梗死患者中为42%；P<0.001）。总的IHM和MACCE发生率分别为8.1%和17.5%，在ST段抬高型心肌梗死患者中最高，分别为12.6%和28.5%（P<0.001）。IHM和MACCE的关键预测因素为女性、肌钙蛋白升高、左心室射血分数、血管活性药物支持、逻辑EuroSCORE、体外循环和主动脉阻断时间以及急诊CABG的需求。
ACS患者的外科心肌血运重建仍与较高的院内死亡率相关。ACS患者的急诊CABG与较差的预后相关。
