急性心肌梗死患者使用动脉移植物是否安全？短期-中期倾向性分析。
Is It Safe to Use Arterial Grafts in Patients with Acute Myocardial Infarction? Short-Mid-Term Propensity Analysis.
机构信息
Department of Cardiovascular Surgery, Hospital Regional São Paulo (HRSP), Xanxerê, Santa Catarina, Brazil.
Department of Cardiovascular Surgery, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil. Department of Cardiovascular Surgery, Hospital Paulistano, São Paulo, São Paulo, Brazil.
出版信息
Braz J Cardiovasc Surg. 2024 Oct 22;e20230384(e20230384):e20230384. doi: 10.21470/1678-9741-2023-0384.
INTRODUCTION
The use of multiple arterial grafts (MAGs) has an impact on patient survival; however, preference for its use in the acute phase of myocardial infarction (AMI) has not yet been established. This study aimed to compare the short-mid-term clinical results of AMI patients undergoing coronary artery bypass grafting (CABG) with a single arterial graft (SAG) vs. MAGs.
METHODS
This is a cross-sectional cohort study of 4,053 patients from the Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). CABG in the AMI was considered when performed between one and seven days after diagnosis (n=238). Thirty-five patients underwent surgery with ≥ 2 arterial grafts (MAG group), population adjustment in SAG group was performed using the propensity score matching (PSM). Clinical follow-up was performed by telephone to assess need for readmission, new AMI, reoperation, and death.
RESULTS
After PSM, 70 patients were evaluated. During hospitalization, a significant statistical difference was observed in the surgery duration: the MAG group had a median of 4.78 hours while the SAG group had 4.11 hours (P=0.040). Within the MAG group, there was a predominance use of bilateral internal thoracic artery (62.86%), followed by radial graft associated with the use of left internal thoracic artery (28.57%) and the combination of the three grafts (8.57%). There were no significant differences between the groups in terms of outcomes up to 30 days after CABG or up to five years after CABG.
CONCLUSION
In REPLICCAR II, usage of MAGs in the AMI was not associated with clinical worsening of patients until the mid-term follow-up.
简介
使用多支动脉移植物（MAGs）对患者的生存有影响；然而，在急性心肌梗死（AMI）的急性期使用它的偏好尚未确定。本研究旨在比较接受冠状动脉旁路移植术（CABG）的 AMI 患者使用单支动脉移植物（SAG）与 MAGs 的短期中期临床结果。
方法
这是来自 Registro Paulista de Cirurgia Cardiovascular II（REPLICCAR II）的 4053 名患者的横断面队列研究。在诊断后 1 至 7 天内进行的 AMI 中的 CABG 被认为是 CABG（n=238）。35 名患者接受了≥2 支动脉移植物（MAG 组）的手术，SAG 组的人群调整使用倾向评分匹配（PSM）进行。通过电话进行临床随访，以评估再次入院、新发 AMI、再次手术和死亡的需求。
结果
在 PSM 后，评估了 70 名患者。在住院期间，手术时间存在显著的统计学差异：MAG 组中位数为 4.78 小时，而 SAG 组中位数为 4.11 小时（P=0.040）。在 MAG 组中，双侧内乳动脉的使用率较高（62.86%），其次是与左内乳动脉联合使用的桡动脉移植物（28.57%）和三种移植物的组合（8.57%）。在 CABG 后 30 天或 CABG 后 5 年内，两组在结果方面没有显著差异。
结论
在 REPLICCAR II 中，MAGs 在 AMI 中的使用直到中期随访并未导致患者临床恶化。
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