Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China; Department of Cardiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Ann Thorac Surg. 2023 Jun;115(6):1421-1428. doi: 10.1016/j.athoracsur.2021.12.063. Epub 2022 Jan 24.
A post-hoc analysis of the Surgical Treatment for Ischemic Heart Failure (STICH) trial was performed to evaluate the perioperative and long-term outcomes after off-pump vs on-pump coronary artery bypass graft surgery in patients with ischemic cardiomyopathy (coronary artery disease with left ventricular ejection fraction 35% or less).
Patients who underwent isolated coronary artery bypass graft surgery were enrolled from the STICH trial. Operative details, perioperative outcomes, and long-term outcomes were compared in a 1-to-2 propensity score matching cohort. The primary outcome was death from any cause.
Among 768 included patients operated on between July 2002 and May 2007, 152 (19.8%) received off-pump and 616 (80.2%) received on-pump coronary artery bypass graft surgery. In the 1-to-2 matched cohort (152 off pump and 304 on pump), off pump was associated with a higher prevalence of multiple arterial grafting (17.1% vs 8.6%, P = .01) and incomplete revascularization (34.2% vs 17.1%, P < .001). The overall 30-day mortality (3.3% vs 5.3%, P = .34) was comparable between the two groups. After a median follow-up of 8.7 years, off-pump surgery was associated with a similar risk of death from any cause (hazard ratio 0.82; 95% confidence interval, 0.61 to 1.09), with comparable estimated all-cause mortality at 1 year (12.5% vs 11.9%), 5 years (32% vs 32.8%), and 10 years (51.4% vs 62.3%). No significant interaction was detected in the subgroup analyses of incomplete revascularization, multiple arterial grafting, and three-vessel disease.
In patients with ischemic cardiomyopathy, off-pump coronary artery bypass graft surgery could be performed with comparable 30-day mortality and similar long-term survival, and appears to have a lower incidence of perioperative morbidities.
对《缺血性心力衰竭的外科治疗（STICH）试验》进行了一项事后分析，以评估缺血性心肌病（左心室射血分数 35%或更低的冠心病）患者行非体外循环与体外循环冠状动脉旁路移植术的围手术期和长期结局。
该研究纳入了来自 STICH 试验的接受单纯冠状动脉旁路移植术的患者。在 1:2 倾向评分匹配队列中比较了手术细节、围手术期结局和长期结局。主要结局是任何原因导致的死亡。
在 2002 年 7 月至 2007 年 5 月期间接受手术的 768 例患者中，152 例（19.8%）接受非体外循环冠状动脉旁路移植术，616 例（80.2%）接受体外循环冠状动脉旁路移植术。在 1:2 匹配队列（152 例非体外循环和 304 例体外循环）中，非体外循环组更常见多支动脉旁路移植术（17.1%比 8.6%，P =.01）和不完全血运重建（34.2%比 17.1%，P <.001）。两组术后 30 天死亡率（3.3%比 5.3%，P =.34）相似。中位随访 8.7 年后，非体外循环手术与任何原因导致的死亡风险相似（风险比 0.82；95%置信区间，0.61 至 1.09），1 年（12.5%比 11.9%）、5 年（32%比 32.8%）和 10 年（51.4%比 62.3%）的全因死亡率估计值相似。在不完全血运重建、多支动脉旁路移植术和三血管疾病的亚组分析中未发现显著的交互作用。
在缺血性心肌病患者中，非体外循环冠状动脉旁路移植术可获得相似的 30 天死亡率和相似的长期生存率，且似乎围手术期并发症发生率较低。
