Department of Thoracic and Cardiovascular Surgery, Heart Surgery Service, Edgardo Rebagliati Martins National Hospital, Lima, Peru.
Alberto Hurtado Medical School, Cayetano Heredia Peruvian University, Lima, Peru.
Braz J Cardiovasc Surg. 2024 Nov 28;e20230242(e20230242):e20230242. doi: 10.21470/1678-9741-2023-0242.
The efficacy and outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) remain uncertain, especially in Latin America. Our study aims to explore survival and shortand mid-term outcomes in the first reported Peruvian registry of patients treated with both techniques.
This is an observational, analytical, and longitudinal study using a propensity score-matched (PSM) analysis in a single-center retrospective registry of 2280 patients during 2000-2019; 846 patients were analyzed after PSM (on-pump = 423 vs. off-pump = 423). Baseline variables, comorbidities, and major outcomes were studied in the short term (≤ 30 days) and in midterm (30 days-36 months) with major adverse cardiac and cerebrovascular events. The matched groups were compared by descriptive, multivariate, and Kaplan-Meier survival analyses.
Before PSM, previous myocardial infarction < 7 days (27.03%) and ejection fraction ≥ 50% (45.72%) were higher in off-pump CABG (P<0.05). After PSM, pre-surgery percutaneous coronary intervention (27.18% vs. 26.71%, P=0.049) and Society of Thoracic Surgeons risk score (1.98% vs. 1.90%, P=0.047) were higher in off-pump CABG. In the short term, there was higher mortality (2.12% vs. 0.47%, P=0.048), blood transfusion > 500 ml (57.91% vs. 7.56%, P=0.049), reintervention (7.32% vs. 2.12%, P=0.045), hospital stay (nine vs. four days, P=0.048), arrhythmia (9.92% vs. 4.96%, P=0.049), and renal failure (20.09% vs. 5.91%, P=0.009) in on-pump CABG. Long-term mortality (4.25% vs. 1.65%, P=0.044), myocardial infarction (17.02% vs. 7.32%, P=0.046), and repeat revascularization (17.49% vs. 8.26%, P=0.045) predominated in on-pump CABG. There was a higher 36-month adjusted survival for off-pump over on-pump CABG (97.88% vs. 93.63%, P=0.046).
This first reported Peruvian registry of patients treated with CABG has demonstrated that off-pump CABG is associated with lower shortand mid-term morbidity and mortality rates and better-adjusted survival rates compared to on-pump CABG; however, further multicenter studies in Latin America are needed to elucidate its benefits over classic on-pump CABG.
在泵冠状动脉旁路移植术（CABG）和非体外循环冠状动脉旁路移植术（off-pump CABG）的疗效和结果仍不确定，尤其是在拉丁美洲。我们的研究旨在探讨首例秘鲁注册中心报告的采用这两种技术治疗的患者的生存和短期及中期结果。
这是一项在单中心回顾性注册中心进行的观察性、分析性和纵向研究，使用倾向评分匹配（PSM）分析，共纳入 2000 年至 2019 年期间的 2280 例患者；PSM 后分析了 846 例患者（on-pump = 423 例，off-pump = 423 例）。在短期（≤30 天）和中期（30 天-36 个月）内，研究了基线变量、合并症和主要结局，主要不良心脏和脑血管事件。通过描述性、多变量和 Kaplan-Meier 生存分析比较匹配组。
在 PSM 之前，off-pump CABG 的既往心肌梗死<7 天（27.03%）和射血分数≥50%（45.72%）较高（P<0.05）。PSM 后，术前经皮冠状动脉介入治疗（27.18%比 26.71%，P=0.049）和胸外科医生协会风险评分（1.98%比 1.90%，P=0.047）在 off-pump CABG 中更高。在短期内，on-pump CABG 的死亡率更高（2.12%比 0.47%，P=0.048）、输血>500ml（57.91%比 7.56%，P=0.049）、再干预（7.32%比 2.12%，P=0.045）、住院时间（9 天比 4 天，P=0.048）、心律失常（9.92%比 4.96%，P=0.049）和肾功能衰竭（20.09%比 5.91%，P=0.009）。长期死亡率（4.25%比 1.65%，P=0.044）、心肌梗死（17.02%比 7.32%，P=0.046）和再次血运重建（17.49%比 8.26%，P=0.045）在 on-pump CABG 中更为常见。off-pump CABG 与 on-pump CABG 相比，36 个月时调整后的生存率更高（97.88%比 93.63%，P=0.046）。
首例秘鲁注册中心报告的接受 CABG 治疗的患者表明，与 on-pump CABG 相比，off-pump CABG 与较低的短期和中期发病率和死亡率以及更好的调整后生存率相关；然而，拉丁美洲还需要进一步的多中心研究来阐明其相对于经典 on-pump CABG 的优势。
