在高风险冠状动脉旁路移植术患者中，术前 IABP 置入是否能显著降低术后并发症？

Is preoperative IABP insertion significantly reducing postoperative complication in augmented high-risk coronary artery bypass grafting patients?

机构信息

Department of Surgery, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Singapore, 117599, Singapore.

Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.

出版信息

J Cardiothorac Surg. 2024 Jun 24;19(1):363. doi: 10.1186/s13019-024-02925-2.

DOI:10.1186/s13019-024-02925-2

PMID:38915058

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11194871/

Abstract

BACKGROUND

The aim of this study was to determine whether pre-operative intra-aortic balloon pump (IABP) insertion improves surgical outcomes in high-risk coronary artery bypass grafting (CABG) patients.

METHODS

Patients with a EuroSCORE II greater than 1.2% who underwent CABG from 2009 to 2016 were included in the study, while those who utilized intra-operative or post-operative IABP were excluded. The analysis included a total of 2907 patients, with 377 patients undergoing preoperative IABP insertion (EuroSCORE II > 5.018%) and 1198 patients in the non-IABP group before matching; after propensity score matching (PSM), both groups consisted of a matched cohort of 250 patients.

RESULTS

30-day mortality events occurred in 9 (3.6%) non-IABP group and in 12 (4.8%) IABP patients (OR: 1.33 95%CI: 0.52-3.58). Kaplan-Meier survival curve analysis showed no significant differences between the two groups in mortality up to one year after the operation (p = 0.72). On multivariate analysis, IABP usage among the PSM patients was associated with lower 30-day mortality (OR: 0.28, 95%CI: 0.07-0.92, P-value = 0.043), 90-day mortality (OR: 0.26, 95%CI: 0.08-0.78, P-value = 0.022) and reduced risk of developing severe respiratory disorders (OR: 0.10, 95%CI:0.01-0.50, P-value = 0.011).

CONCLUSION

Pre-operative IABP use in high-risk patients reduces 30- and 90-day mortality rates, along with a notable decrease in rates of severe respiratory disorders.

摘要

背景

本研究旨在确定高危冠状动脉旁路移植术（CABG）患者术前主动脉内球囊泵（IABP）置入是否能改善手术结果。

方法

纳入 2009 年至 2016 年接受 CABG 治疗且 EuroSCORE II 大于 1.2%的患者，排除术中或术后使用 IABP 的患者。该分析共纳入 2907 例患者，其中 377 例患者（EuroSCORE II>5.018%）术前接受 IABP 置入，1198 例患者在匹配前未接受 IABP 治疗；在进行倾向评分匹配（PSM）后，两组各有 250 例匹配患者。

结果

非 IABP 组和 IABP 组 30 天死亡率分别为 9（3.6%）例和 12（4.8%）例（OR：1.33，95%CI：0.52-3.58）。Kaplan-Meier 生存曲线分析显示，两组患者术后 1 年死亡率无显著差异（p=0.72）。多变量分析显示，PSM 患者中 IABP 使用率与 30 天死亡率（OR：0.28，95%CI：0.07-0.92，P 值=0.043）、90 天死亡率（OR：0.26，95%CI：0.08-0.78，P 值=0.022）和严重呼吸系统疾病风险降低相关（OR：0.10，95%CI：0.01-0.50，P 值=0.011）。