Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va.
Department of Cardiothoracic Surgery, Carilion Clinic, Roanoke, Va.
J Thorac Cardiovasc Surg. 2024 Oct;168(4):1094-1106.e1. doi: 10.1016/j.jtcvs.2023.08.039. Epub 2023 Sep 1.
Literature describing outcomes of myocardial ischemia after coronary artery bypass grafting is sparse. We hypothesized these patients had more complications and incurred higher costs of care.
Using adult cardiac surgery data and cardiac catheterization (CathPCI) data from the Virginia Cardiac Services Quality Initiative, we identified patients who underwent unplanned cardiac catheterization after coronary artery bypass grafting from 2018 to 2021. Adult cardiac surgery data were matched to CathPCI data examining earliest in-hospital catheterization. Patients not requiring catheterization served as the control group.
We identified 10,597 patients who underwent isolated coronary artery bypass grafting, of whom 41 of 10,597 underwent unplanned cardiac catheterization. A total of 21 of 41 patients (51%) received percutaneous coronary intervention, most commonly for non-ST-elevation myocardial infarction (n = 7, 33%) and ST-elevation myocardial infarction (n = 6, 29%). Postoperative cardiac arrest occurred in 14 patients (40%). In patients who underwent percutaneous coronary intervention, 14 (67%) had a single lesion, 4 (19%) had 2 lesions, and 3 (14%) had 3 lesions. The left anterior descending artery (38%) was the most frequently intervened upon vessel. Patients who underwent catheterization were more likely to require balloon pump support (26% vs 11%), to have prolonged ventilation (57% vs 20%), to have renal failure (17% vs 7.1%), and to undergo reintubation (37% vs 3.8%, all P < .04). There was no statistical difference in operative mortality (4.9% vs 2.3%, P = .2) or failure to rescue (4.9% vs 1.6%, P = .14). Total costs were higher in patients who underwent unplanned catheterization ($81,293 vs $37,011, P < .001).
Unplanned catheterization after coronary artery bypass grafting is infrequent but associated with more complications and a higher cost of care. Therefore, determination of an association with operative mortality in patients with suspected ischemia after coronary artery bypass grafting requires additional study.
描述冠状动脉旁路移植术后心肌缺血的文献很少。我们假设这些患者有更多的并发症，并且需要更高的治疗费用。
利用弗吉尼亚心脏服务质量倡议的成人心脏手术数据和心脏导管插入术（CathPCI）数据，我们确定了 2018 年至 2021 年间行冠状动脉旁路移植术后接受非计划性心脏导管插入术的患者。成人心脏手术数据与最早在院内进行的导管插入术的 CathPCI 数据相匹配。不需要导管插入术的患者作为对照组。
我们共确定了 10597 例接受单纯冠状动脉旁路移植术的患者，其中 41 例（41/10597）行非计划性心脏导管插入术。共有 41 例患者中的 21 例（21/41，51%）接受了经皮冠状动脉介入治疗，最常见的是用于非 ST 段抬高型心肌梗死（n=7，33%）和 ST 段抬高型心肌梗死（n=6，29%）。术后心脏骤停发生在 14 例患者（40%）中。接受经皮冠状动脉介入治疗的患者中，14 例（67%）为单支病变，4 例（19%）为 2 支病变，3 例（14%）为 3 支病变。左前降支（38%）是最常介入的血管。行导管插入术的患者更可能需要球囊泵支持（26%比 11%）、需要延长通气（57%比 20%）、发生肾衰竭（17%比 7.1%）和再次插管（37%比 3.8%，均 P<0.04）。手术死亡率（4.9%比 2.3%，P=0.2）或抢救失败（4.9%比 1.6%，P=0.14）无统计学差异。行非计划性导管插入术的患者总费用较高（81293 美元比 37011 美元，P<0.001）。
冠状动脉旁路移植术后非计划性导管插入术并不常见，但与更多的并发症和更高的治疗费用相关。因此，需要进一步研究在怀疑冠状动脉旁路移植术后缺血的患者中，这种情况与手术死亡率之间的关联。
