Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Heart Lung Circ. 2023 Oct;32(10):1257-1268. doi: 10.1016/j.hlc.2023.08.005. Epub 2023 Sep 22.
To determine whether primary percutaneous coronary intervention (PPCI) is associated with adverse outcomes following coronary artery bypass graft (CABG) among patients with ST-elevation myocardial infarction (STEMI).
Patients presenting with acute STEMI who underwent CABG between September 2015 and November 2020 were included. Among 354 patients, 222 (62.7%) underwent PPCI prior to CABG (PPCI+CABG group) and were compared with the rest of the patients (CABG only group). The effects of PPCI on primary endpoints---including in-hospital mortality, length of stay (LOS), and bleeding events---were investigated using the stabilised inverse probability weighting method (S-IPW). Further, in-hospital mortality in various PPCI subgroups was analysed using univariable regression.
Patients with and without PPCI were comparable regarding their baseline and surgical characteristics, except that those without PPCI were more likely to have left-main disease (29.5% vs 16.2%, p-value=0.003). Among the PPCI+CABG group, 3.6% mortality and 55.9% bleeding events occurred, and the LOS was 7 [5-10] days. The respective figures for the CABG only group were 4.5%, 50.8%, and 7 [6-10.5] days. Primary percutaneous coronary intervention, as a whole, was not significantly associated with either morality (S-IPW odds ratio (S-IPW OR) 0.61; p=0.393), LOS logarithm (S-IPW β -0.050; p=0.403), or bleeding events (S-IPW OR 1.06; p=0.821). Nevertheless, the unadjusted mortality risk was significantly higher in complicated PPCIs compared with the CABG only group (OR 7.50, 95% CI 2.03-27.77); it was also higher among some other PPCI subgroups, albeit non-significantly.
This study found that PPCI did not confer additional risk regarding in-hospital mortality, LOS, or bleeding among patients with acute STEMI who underwent CABG. However, some PPCI subgroups, especially those with complicated PPCI, were at increased risk.
确定在急性 ST 段抬高型心肌梗死（STEMI）患者中，经皮冠状动脉介入治疗（PPCI）与冠状动脉旁路移植术（CABG）后不良结局的相关性。
纳入 2015 年 9 月至 2020 年 11 月期间行 CABG 的急性 STEMI 患者。在 354 例患者中，222 例（62.7%）在 CABG 前接受了 PPCI（PPCI+CABG 组），并与其余患者（仅 CABG 组）进行了比较。采用稳定逆概率加权法（S-IPW）研究 PPCI 对主要终点（包括院内死亡率、住院时间（LOS）和出血事件）的影响。此外，使用单变量回归分析了各种 PPCI 亚组的院内死亡率。
接受和未接受 PPCI 的患者在基线和手术特征方面无差异，除了未接受 PPCI 的患者更可能患有左主干疾病（29.5% vs 16.2%，p 值=0.003）。在 PPCI+CABG 组中，死亡率为 3.6%，出血事件发生率为 55.9%，LOS 为 7[5-10]天。仅 CABG 组的相应数据分别为 4.5%、50.8%和 7[6-10.5]天。总体而言，PPCI 与死亡率（S-IPW 比值比（S-IPW OR）0.61；p=0.393）、LOS 对数（S-IPWβ-0.050；p=0.403）或出血事件（S-IPW OR 1.06；p=0.821）均无显著相关性。然而，与仅 CABG 组相比，复杂 PPCI 的未调整死亡率风险显著更高（OR 7.50，95%CI 2.03-27.77）；在其他一些 PPCI 亚组中，尽管没有统计学意义，但风险也更高。
本研究发现，在接受 CABG 的急性 STEMI 患者中，PPCI 不会增加院内死亡率、LOS 或出血风险。然而，某些 PPCI 亚组，尤其是复杂 PPCI 亚组，风险增加。
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