美国急性心肌梗死后急诊冠状动脉旁路移植术的时间趋势、临床特征和结局。
Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States.
机构信息
Department of Cardiovascular Surgery Mayo Clinic Rochester MN.
University of Minnesota Minneapolis MN.
出版信息
J Am Heart Assoc. 2021 Aug 3;10(15):e020517. doi: 10.1161/JAHA.120.020517. Epub 2021 May 15.
Background There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction. Methods and Results Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000-2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age-, sex-, and race-stratified trends in CABG use; in-hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98-0.98]; <0.001), in ST-segment-elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95-0.95]; <0.001) and non-ST-segment-elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99-0.99]; <0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non-ST-segment-elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In-hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88-0.89 [<0.001]) in the overall cohort, with similar temporal trends in patients with ST-segment-elevation myocardial infarction and non-ST-segment-elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time. Conclusions Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST-segment-elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in-hospital mortality consistently decreased in this population.
背景
目前关于急性心肌梗死患者中紧急冠状动脉旁路移植术（CABG）的应用，仅有少量的当代数据。
方法和结果
本研究使用国家（全国）住院患者样本（2000-2017 年），按入院年份的三分位数将成年（>18 岁）急性心肌梗死患者进行分类，以此确定了 CABG 的使用情况。感兴趣的结果包括 CABG 使用的时间趋势；按年龄、性别和种族分层的 CABG 使用趋势；住院死亡率；住院费用；以及住院时间。在 11622528 例急性心肌梗死入院患者中，有 1071156 例（9.2%）进行了紧急 CABG。总体而言，CABG 的使用率有所下降（10.5%[2000 年]至 8.7%[2017 年]；调整后的优势比[OR]，0.98[95%CI，0.98-0.98]；<0.001），ST 段抬高型心肌梗死（10.2%[2000 年]至 5.2%[2017 年]；调整后的 OR，0.95[95%CI，0.95-0.95]；<0.001）和非 ST 段抬高型心肌梗死（10.8%[2000 年]至 10.0%[2017 年]；调整后的 OR，0.99[95%CI，0.99-0.99]；<0.001），且年龄、性别和种族的趋势一致。2012 年至 2017 年，与 2000 年至 2005 年相比，接受紧急 CABG 的入院患者更有可能患有非 ST 段抬高型心肌梗死（80.5%比 56.1%），非心脏多器官衰竭（26.1%比 8.4%）、心源性休克（11.5%比 6.4%）和机械循环支持（19.8%比 18.7%）的使用率更高。在整个队列中，CABG 入院患者的住院死亡率从 5.3%（2000 年）降至 3.6%（2017 年）（调整后的 OR，0.89；95%CI，0.88-0.89；<0.001），ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死患者也呈现出类似的时间趋势。随着时间的推移，住院时间和住院费用呈增加趋势。
结论
急性心肌梗死患者中 CABG 的使用率大幅下降，尤其是 ST 段抬高型心肌梗死患者。尽管病情严重程度和多器官衰竭有所增加，但该人群的住院死亡率持续下降。
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