Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. Electronic address: https://twitter.com/alomarymsami.
Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia.
Heart Lung Circ. 2021 Jun;30(6):888-895. doi: 10.1016/j.hlc.2020.09.935. Epub 2020 Nov 13.
Diagnosis of critical coronary artery disease, including after acute coronary syndrome presentation (ACS), represents an important indication for early coronary artery bypass graft (CABG) surgery. The study aims to investigate the influence of time from diagnosis to CABG on outcomes and document barriers to early revascularisation.
All patients 18 years and older with an acute presentation due to ACS or critical coronary artery disease who were considered to require urgent inpatient cardiac surgery between January 2016-February 2019 were included in the study. The primary endpoints were 30-day all-cause mortality or readmission, 1-year all-cause mortality, all-cause readmission. The secondary endpoint was the rate of complications while waiting for surgery. The time duration between diagnostic coronary angiography and surgery was considered as the time interval.
Of 266 eligible patients, 251 underwent surgical revascularisation with 15 (6%) not undergoing surgery due to preoperative complications (n=12) or due to perceived prohibitively high surgical risk (n=3). The majority (85%) were male (mean age 67 years), 37% of patients had diabetes and 71% had hypertension. Non-ST elevation myocardial infarction was documented in 51% of the patients. The median time between diagnosis and inpatient CABG was 7 days (IQR 5-11). Thirty-five per cent (35%) of patients experienced complications while awaiting surgery. Of the 266 patients, 140 patients (53% - cohort 1) underwent surgery within 7 days. The cohort 1 rate of complications was lower than in cohort 2 (surgery after 7 days) (24 vs 47%, p<0.001). Moreover, 1-year mortality was less in cohort 1 (2 vs 8%, p=0.029).
In patients requiring urgent inpatient CABG, delay for more than 7 days is associated with a higher rate of in-hospital complications and worse 30 day and 12-month outcomes.
包括急性冠脉综合征（ACS）发作后的严重冠状动脉疾病的诊断是早期进行冠状动脉旁路移植术（CABG）的重要指征。本研究旨在探讨从诊断到 CABG 的时间对结果的影响，并记录早期血运重建的障碍。
本研究纳入了 2016 年 1 月至 2019 年 2 月期间因 ACS 或严重冠状动脉疾病急性发作而被认为需要紧急住院心脏手术的所有 18 岁及以上的患者。主要终点为 30 天全因死亡率或再入院率、1 年全因死亡率、全因再入院率。次要终点为手术前等待期间并发症的发生率。将诊断性冠状动脉造影与手术之间的时间间隔作为时间间隔。
在 266 名符合条件的患者中，251 名接受了手术血运重建，其中 15 名（6%）因术前并发症（n=12）或因认为手术风险过高（n=3）而未接受手术。大多数（85%）为男性（平均年龄 67 岁），37%的患者患有糖尿病，71%的患者患有高血压。51%的患者记录了非 ST 段抬高型心肌梗死。从诊断到住院 CABG 的中位时间为 7 天（IQR 5-11）。35%（35%）的患者在等待手术期间出现并发症。在 266 名患者中，有 140 名患者（53% - 队列 1）在 7 天内接受了手术。队列 1 的并发症发生率低于队列 2（术后 7 天）（24% vs 47%，p<0.001）。此外，队列 1 的 1 年死亡率较低（2% vs 8%，p=0.029）。
在需要紧急住院 CABG 的患者中，延迟超过 7 天与更高的住院期间并发症发生率和更差的 30 天和 12 个月结局相关。
