Li Renxi, Luo Qianyun, Huddleston Stephen J
The George Washington University School of Medicine and Health Sciences, United States of America; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, United States of America.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota Medical School, United States of America.
Cardiovasc Revasc Med. 2024 Dec;69:62-67. doi: 10.1016/j.carrev.2024.05.029. Epub 2024 May 22.
Metastasis is a hallmark for cancer progression. While patients with metastatic cancer (MC) have higher risk profiles, outcomes of coronary artery bypass grafting (CABG) in these patients have not been established, likely due to their smaller representation in the CABG patient population. This study aimed to examine the short-term outcomes of patients with MC who underwent CABG.
Patients who underwent CABG were identified in National Inpatient Sample from Q4 2015-2020. Exclusion criteria included age <18 years, concomitant procedures, and non-metastatic malignancies. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between MC and non-MCC patients. In-hospital post-CABG outcomes were evaluated.
There were 379 (0.23 %) patients with MC who underwent CABG. All MC patients were matched to 1161 out of 164,351 non-MC patients who underwent CABG during the same period. Patients with MC had higher risks of mortality (4.76 % vs 2.58 %, p = 0.04), pacemaker implantation (2.91 % vs 1.12 %, p = 0.03), venous thromboembolism (1.85 % vs 0.43 %, p = 0.01), and hemorrhage/hematoma (61.11 % vs 55.04 %, p = 0.04). In addition, MC patients had a longer time from admission to operation (3.35 ± 4.19 vs 2.82 ± 3.54 days, p = 0.03) and longer hospital length of stay (11.86 ± 8.17 vs 10.65 ± 8.08 days, p = 0.01).
Patients with MC had higher short-term mortality and morbidities after CABG. These findings can help provide insights for clinicians in the management of patients with concurrent coronary artery disease and MC, particularly in terms of preoperative risk stratification and therapeutic decision-making.
转移是癌症进展的一个标志。虽然转移性癌症（MC）患者具有更高的风险特征，但这些患者接受冠状动脉旁路移植术（CABG）的结果尚未明确，这可能是因为他们在CABG患者群体中的占比相对较小。本研究旨在探讨接受CABG的MC患者的短期结局。
在2015年第四季度至2020年的国家住院患者样本中识别接受CABG的患者。排除标准包括年龄<18岁、同期手术以及非转移性恶性肿瘤。采用1:3倾向评分匹配法来处理MC患者与非MC患者在人口统计学、社会经济地位、主要支付者状态、医院特征、合并症以及转诊/入院状态方面的差异。评估CABG术后的院内结局。
共有379例（0.23%）MC患者接受了CABG。所有MC患者与同期接受CABG的164351例非MC患者中的1161例进行了匹配。MC患者的死亡风险（4.76%对2.58%，p = 0.04）、起搏器植入风险（2.91%对1.12%，p = 0.03）、静脉血栓栓塞风险（1.85%对0.43%，p = 0.01）以及出血/血肿风险（61.11%对55.04%，p = 0.04）更高。此外，MC患者从入院到手术的时间更长（3.35±4.19天对2.82±3.54天，p = 0.03），住院时间也更长（11.86±8.17天对10.65±8.08天，p = 0.01）。
MC患者在CABG术后具有更高的短期死亡率和发病率。这些发现有助于为临床医生管理合并冠状动脉疾病和MC的患者提供见解，特别是在术前风险分层和治疗决策方面。
