Kim Ju Hyeon, Lee Pil Hyung, Kim Ho Jin, Kim Joon Bum, Park Sojeong, Kyoung Dae-Sung, Kang Soo-Jin, Lee Seung-Whan, Kim Young-Hak, Lee Cheol Whan, Chung Cheol Hyun, Lee Jae Won, Park Seong-Wook
Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Front Cardiovasc Med. 2022 Aug 12;9:863590. doi: 10.3389/fcvm.2022.863590. eCollection 2022.
There is a paucity of direct data on the incidence and predictors of intracranial bleeding (ICB) after coronary artery bypass graft surgery (CABG).
The Korean National Health Insurance database was used to identify patients without prior ICB who underwent CABG. The outcomes of interest were the time-dependent incidence rates of ICB and the associated mortality.
Among 35,021 patients who underwent CABG between 2007 and 2018, 895 (2.6%) experienced an ICB during a median follow-up of 6.0 years. The 1-year cumulative incidence of ICB was 0.76%, with a relatively high incidence rate (9.93 cases per 1,000 person-years) within the first 1-30 days. Subsequent incidence rates showed a sharp decline until 3 years, followed by a steady decrease up to 10 years. The 1-year mortality rate after ICB was 38.1%, with most deaths occurring within 30 days (23.6%). The predictors of ICB after CABG were age ≥ 75 years, hypertension, pre-existing dementia, history of ischemic stroke or transient ischemic attack, and end-stage renal disease.
In an unselected nationwide population undergoing CABG, the incidence of ICB was non-negligible and showed a relatively high incidence rate during the early postoperative period. Post-CABG ICB was associated with a high risk of premature death. Further research is needed to stratify high-risk patients and personalize therapeutic decisions for preventing ICB after CABG.
关于冠状动脉旁路移植术（CABG）后颅内出血（ICB）的发生率及预测因素，直接数据较为匮乏。
利用韩国国民健康保险数据库确定无既往ICB且接受CABG的患者。感兴趣的结局为ICB的时间依赖性发生率及相关死亡率。
在2007年至2018年间接受CABG的35021例患者中，895例（2.6%）在中位随访6.0年期间发生了ICB。ICB的1年累积发生率为0.76%，在术后第1至30天内发生率相对较高（每1000人年9.93例）。随后的发生率在3年内急剧下降，之后直至10年稳步下降。ICB后的1年死亡率为38.1%，大多数死亡发生在30天内（23.6%）。CABG后ICB的预测因素为年龄≥75岁、高血压、既往痴呆、缺血性中风或短暂性脑缺血发作史以及终末期肾病。
在未经过筛选的全国范围内接受CABG的人群中，ICB的发生率不可忽视，且在术后早期显示出相对较高的发生率。CABG后ICB与过早死亡的高风险相关。需要进一步研究对高危患者进行分层，并为预防CABG后ICB制定个性化治疗决策。
