Bianchi Giacomo, Zancanaro Edoardo, Margaryan Rafik, Concistré Giovanni, Varone Egidio, Simeoni Simone, Solinas Marco
Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy.
Department of Cardiac Surgery, Università Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy.
Life (Basel). 2022 Dec 16;12(12):2124. doi: 10.3390/life12122124.
Patients with previously diagnosed HF are at greater risk for subsequent morbidity and mortality when hospitalized for an Acute Myocardial Infarction (AMI). The purpose of our study was to describe the time trend of the incidence of emergent CABG in patients with and without HF, the clinical characteristics, outcomes, and the risk factors for mortality of surgical revascularization in the short and medium term. This was a single-center retrospective observational study of patients who underwent isolated emergency CABG from January 2009 to January 2020. A propensity-score matching analysis yielded two comparable groups (n = 430) of patients without (n = 215) and with (n = 215) heart failure. In-hospital mortality did not differ in the two groups (2.8%; p > 0.9); the patients with heart failure presented more frequently with cardiogenic shock, and there was an association with mortality and mechanical circulatory support (OR 16.7−95% CI 3.31−140; p = 0.002) and postoperative acute renal failure (OR 15.9−95% CI 0.66−203; p = 0.036). In the early- and mid-term, heart failure and NSTEMI were associated with mortality (HR 3.47−95% CI 1.15−10.5; p = 0.028), along with age (HR 1.28−95% CI 1.21−1.36; p < 0.001). Surgical revascularization offers an excellent solution for patients with acute coronary syndrome, leading to a good immediate prognosis even in those with chronic heart failure.
既往诊断为心力衰竭（HF）的患者因急性心肌梗死（AMI）住院时，发生后续发病和死亡的风险更高。我们研究的目的是描述有和没有HF的患者中急诊冠状动脉旁路移植术（CABG）发生率的时间趋势、临床特征、结局以及短期和中期手术血运重建的死亡危险因素。这是一项对2009年1月至2020年1月期间接受单纯急诊CABG的患者进行的单中心回顾性观察研究。倾向评分匹配分析产生了两组可比的患者（n = 430），其中无心力衰竭（n = 215）和有心力衰竭（n = 215）。两组的住院死亡率无差异（2.8%；p > 0.9）；心力衰竭患者更常出现心源性休克，且与死亡率和机械循环支持相关（比值比[OR] 16.7−95%置信区间[CI] 3.31−140；p = 0.002）以及术后急性肾衰竭（OR 15.9−95% CI 0.66−203；p = 0.036）。在早期和中期，心力衰竭和非ST段抬高型心肌梗死（NSTEMI）与死亡率相关（风险比[HR] 3.47−95% CI 1.15−10.5；p = 0.028），年龄也相关（HR 1.28−95% CI 1.21−1.36；p < 0.001）。手术血运重建为急性冠状动脉综合征患者提供了一个很好的解决方案，即使对于慢性心力衰竭患者也能带来良好的近期预后。
