Liu Yu, Wang Le-Feng, Yang Xin-Chun, Su Pi-Xiong, Li Kui-Bao, Wang Hong-Shi, Chen Mu-Lei, Xu Li, Zhong Jiu-Chang
Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
J Thorac Dis. 2021 Mar;13(3):1737-1745. doi: 10.21037/jtd-20-1813.
This study aims to analyze the in-hospital outcome of primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) and prior coronary artery bypass grafting (CABG).
This was a retrospective study. From January 2011 to December 2018, the data of 78 consecutive patients (study group) with prior CABG, who received primary coronary angiography in the setting of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), were screened. The study group was compared with another well-matched 78 patients without a history of CABG (control group). The information of the coronary angiograms and clinical data of both groups were analyzed. Multivariate conditional logistic regression models were constructed to test the association between PCI success rate and the prior CABG at age ≥65 and <65 years, respectively.
The results revealed that the primary PCI success rate in the study group was significantly lower than in the control group (67.9% . 92.3%, P<0.001) and in-hospital mortality was significantly higher than in control group (11.5% . 2.5%, P=0.03). The multivariate logistic regression analysis indicated that the primary PCI success rate was significantly associated with the history of prior CABG both in young patients [age <65 years; odds ratio (OR) =5.26, 95% confidence interval (CI): 1.69-16.47] and elderly (age ≥65 years; OR =13.76, 95% CI: 2.72-69.75).
The patients who receive primary PCI with AMI and prior CABG have poor in-hospital outcomes, with low PCI success rates and high mortality.
本研究旨在分析急性心肌梗死（AMI）合并既往冠状动脉旁路移植术（CABG）患者接受急诊经皮冠状动脉介入治疗（PCI）的院内结局。
这是一项回顾性研究。筛选了2011年1月至2018年12月期间78例连续的既往有CABG史的患者（研究组），这些患者在ST段抬高型心肌梗死（STEMI）或非ST段抬高型心肌梗死（NSTEMI）情况下接受了急诊冠状动脉造影。将研究组与另外78例无CABG病史且匹配良好的患者（对照组）进行比较。分析了两组的冠状动脉造影信息和临床数据。构建多变量条件逻辑回归模型，分别检验年龄≥65岁和<65岁时PCI成功率与既往CABG之间的关联。
结果显示，研究组的急诊PCI成功率显著低于对照组（67.9%对92.3%，P<0.001），院内死亡率显著高于对照组（11.5%对2.5%，P=0.03）。多变量逻辑回归分析表明，无论年轻患者（年龄<65岁；优势比[OR]=5.26，95%置信区间[CI]：1.69-16.47）还是老年患者（年龄≥65岁；OR=13.76，95%CI：2.72-69.75），急诊PCI成功率均与既往CABG史显著相关。
急性心肌梗死合并既往CABG史的患者接受急诊PCI时院内结局较差，PCI成功率低且死亡率高。
