慢性阻塞性肺疾病是否会影响冠状动脉旁路移植术后的结局？一项基于德国人群的回顾性研究。
Does Chronic Obstructive Pulmonary Disease Impact Outcome after Coronary Artery Bypass Grafting? A Population-Based Retrospective Study in Germany.
作者信息
Hochhausen Nadine, Sales Marjolijn C, Ramnath Natasja W M, Billig Sebastian, Kork Felix, Moza Ajay
机构信息
Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
出版信息
J Clin Med. 2024 Aug 29;13(17):5131. doi: 10.3390/jcm13175131.
The interaction between chronic obstructive pulmonary disease (COPD) and coronary artery bypass grafting (CABG) is discussed controversial. In this population-based retrospective analysis including non-emergency CABG in Germany between 2015 and 2021, the aim was to compare in-hospital mortality, hospital length of stay (HLOS), and perioperative ventilation time (VT) in patients affected by COPD and not affected by COPD. In addition, we compared outcomes after off-pump coronary artery bypass (OPCAB) and on-pump coronary artery bypass (ONCAB) surgery and outcomes after CABG with a minimally invasive technique with and without cardiopulmonary bypass (CPB) in COPD patients. Of the 274,792 analyzed cases undergoing non-emergency CABG, 7.7% suffered from COPD. COPD patients showed a higher in-hospital mortality (6.0% vs. 4.2%; < 0.001), a longer HLOS (13 days (10-19) vs. 12 days (9-16); < 0.001), and a longer VT (33 h (11-124) vs. 28 h (9-94); < 0.001). In subgroup analyses, COPD patients undergoing OPCAB surgery showed a lower in-hospital mortality (3.5% vs. 6.4%; < 0.001), a shorter HLOS (12 days (9-16) vs. 13 days (10-19); < 0.001) and a shorter VT (20 h (10-69) vs. 36 h (11-135); < 0.001) compared to ONCAB surgery. Regression analyses confirmed that using cardiopulmonary bypass in COPD patients is associated with a higher risk of in-hospital mortality (OR, 1.86; 95% CI: 1.51-2.29, < 0.001), a longer HLOS (1.44 days; 95% CI: 0.91-1.97, < 0.001), and a longer VT (33.67 h; 95% CI: 18.67-48.66, < 0.001). In further subgroup analyses, COPD patients undergoing CABG with a minimally invasive technique without CPB showed a lower in-hospital mortality (3.5% vs. 16.5%; < 0.001) and a shorter VT (20 h (10-69) vs. 65 h (29-210); < 0.001) compared to CABG with a minimally invasive technique and CPB. Regression analyses confirmed that using CPB in COPD patients undergoing CABG with a minimally invasive technique is associated with a higher risk of in-hospital mortality (OR, 4.80; 95% CI: 2.42-9.51, < 0.001). COPD negatively impacts outcomes after non-emergency CABG. According to our results, OPCAB surgery and CABG with a minimally invasive technique without CPB seem to be beneficial for COPD patients. Further studies should be performed to confirm this.
慢性阻塞性肺疾病（COPD）与冠状动脉旁路移植术（CABG）之间的相互作用存在争议。在这项基于人群的回顾性分析中，纳入了2015年至2021年在德国进行的非急诊CABG病例，目的是比较COPD患者和非COPD患者的院内死亡率、住院时间（HLOS）和围手术期通气时间（VT）。此外，我们还比较了非体外循环冠状动脉旁路移植术（OPCAB）和体外循环冠状动脉旁路移植术（ONCAB）的手术结果，以及COPD患者采用有或无体外循环（CPB）的微创技术进行CABG后的结果。在274792例接受非急诊CABG的分析病例中，7.7%患有COPD。COPD患者的院内死亡率更高（6.0%对4.2%；<0.001），HLOS更长（13天（10 - 19天）对12天（9 - 16天）；<0.001），VT更长（33小时（11 - 124小时）对28小时（9 - 94小时）；<0.001）。在亚组分析中，与ONCAB手术相比，接受OPCAB手术的COPD患者院内死亡率更低（3.5%对6.4%；<0.001），HLOS更短（12天（9 - 16天）对13天（10 - 19天）；<0.001），VT更短（20小时（10 - 69小时）对36小时（11 - 135小时）；<0.001）。回归分析证实，COPD患者使用体外循环与院内死亡风险更高相关（OR，1.86；95%CI：1.51 - 2.29，<0.001），HLOS更长（1.44天；95%CI：0.91 - 1.97，<0.001），VT更长（33.67小时；95%CI：18.67 - 48.66，<0.001）。在进一步的亚组分析中，与采用微创技术并使用CPB的CABG相比，采用无CPB的微创技术进行CABG的COPD患者院内死亡率更低（3.5%对16.5%；<0.001），VT更短（20小时（10 - 69小时）对65小时（29 - 210小时）；<0.001）。回归分析证实，在采用微创技术进行CABG的COPD患者中使用CPB与更高的院内死亡风险相关（OR，4.80；95%CI：2.42 - 9.51，<0.001）。COPD对非急诊CABG后的结果有负面影响。根据我们的结果，OPCAB手术和采用无CPB的微创技术进行CABG似乎对COPD患者有益。应进行进一步研究以证实这一点。
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