Division of Cardiovascular Surgery, Nihonkai General Hospital, Sakata, Japan.
Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
BMC Cardiovasc Disord. 2024 Mar 4;24(1):139. doi: 10.1186/s12872-024-03757-7.
In patients with stable hemodynamic status after an acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) after preoperative investigations can provide outcomes comparable to those of emergency surgery. However, no established guidelines exist regarding the preparation period before surgery. We report the results of the use of an inpatient cardiac rehabilitation program followed by CABG after an ACS to improve post-operative outcomes and prognosis after discharge.
From 2005 to 2017, 471 patients underwent either isolated or combined CABG at our institution, and of those, the 393 who received isolated CABG were included in the analysis. Twenty-seven patients (6.9%) were admitted with ACS and underwent preoperative rehabilitation before undergoing CABG, with a subsequent review of surgical morbidity and mortality rates. Propensity score matching yielded a cohort of 26 patients who underwent preoperative rehabilitation (group A) and 26 controls (group B). Preoperative characteristics were similar between groups.
The completion rate of the rehabilitation program was 96.3%. All programs were conducted with inpatients, with an average length of stay of 23 ± 12 days. All patients completed in-bed exercises, and 85% completed out-of-bed exercises. The 30-day postoperative mortality was 0% in both groups A and B, and the rate of postoperative major adverse cardiac or cerebrovascular events at 12 months did not differ significantly between groups (7.7% vs 3.9%, respectively; p = 1.0). The duration of mechanical ventilation (1.3 ± 0.3 vs 1.5 ± 0.3 days, respectively; p = 0.633), length of intensive care unit stay (4.4 ± 2.1 vs 4.8 ± 2.3 days, respectively; p = 0.584) and length of hospital stay (25 ± 13 vs 22 ± 9 days, respectively; p = 0.378) did not differ significantly between groups.
No complications of preoperative rehabilitation were observed, suggesting that it is an acceptable option for patients who experience ACS and undergo CABG. These results are promising in offering more robust designs of future trials.
在急性冠状动脉综合征（ACS）后血流动力学稳定的患者中，术前检查后的冠状动脉旁路移植术（CABG）可提供与急诊手术相当的结果。然而，目前尚不存在关于手术前准备期的既定指南。我们报告了使用住院心脏康复计划的结果，该计划随后在 ACS 后进行 CABG，以改善术后结果和出院后的预后。
2005 年至 2017 年，我院共行 471 例单纯或联合 CABG，其中 393 例单纯 CABG 患者纳入分析。27 例（6.9%）因 ACS 入院，在接受 CABG 术前进行康复治疗，随后回顾手术发病率和死亡率。采用倾向评分匹配得到一组 26 例接受术前康复治疗的患者（A 组）和 26 例对照组（B 组）。两组间术前特征相似。
康复计划的完成率为 96.3%。所有计划均在住院患者中进行，平均住院时间为 23±12 天。所有患者均完成卧床运动，85%完成离床运动。两组的 30 天术后死亡率均为 0%，两组 12 个月的术后主要心脏或脑血管不良事件发生率无显著差异（分别为 7.7%和 3.9%，p=1.0）。机械通气时间（分别为 1.3±0.3 天和 1.5±0.3 天，p=0.633）、重症监护病房住院时间（分别为 4.4±2.1 天和 4.8±2.3 天，p=0.584）和住院时间（分别为 25±13 天和 22±9 天，p=0.378）均无显著差异。
术前康复无并发症发生，提示对于 ACS 后行 CABG 的患者，该方案是一种可接受的选择。这些结果为未来试验提供了更有力的设计方案。
