Rustenbach Christian Jörg, Schano Julia, Salewski Christoph, Häberle Helene, Ngamsri Kristian-Christos, Djordjevic Ilija, Wendt Stefanie, Caldonazo Tulio, Saqer Ibrahim, Saha Shekhar, Schnackenburg Philipp, Serna-Higuita Lina Maria, Doenst Torsten, Hagl Christian, Wahlers Thorsten, Schlensak Christian, Reichert Stefan
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany.
Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany.
Med Sci (Basel). 2025 Sep 5;13(3):179. doi: 10.3390/medsci13030179.
Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017-2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) ( = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, < 0.001), shorter hospital stay (10 d vs. 12 d, = 0.002), reduced ventilation time (8 h vs. 12 h, < 0.001), lower delirium (5.0% vs. 14.2%, = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, < 0.001). In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits.
全动脉血管重建术（TAR）可能改善缺血性心肌病和射血分数降低的心力衰竭（HFrEF）患者的预后。我们对德国四个中心（2017 - 2023年）接受单纯冠状动脉旁路移植术（CABG）的574例HFrEF成人患者（左心室射血分数[LVEF] < 40%）进行了回顾性筛查。经过1:1倾向评分匹配后，对240例患者进行了分析（120例TAR组与120例非TAR组[NTAR]）。主要终点是院内主要不良心血管和脑血管事件（MACCE，包括死亡、心肌梗死、中风）。关键次要终点包括重症监护病房/住院时间、通气时间、谵妄、输血需求和急性肾损伤。MACCE发生率在TAR组为4.1%，而NTAR组为14.2%（P = 0.007）。TAR与较短的重症监护病房住院时间相关（中位数44.5小时对90小时，P < 0.001）、较短的住院时间（10天对12天，P = 0.002）、减少的通气时间（8小时对12小时，P < 0.001）、较低的谵妄发生率（5.0%对14.2%，P = 0.016）以及术中较少的红细胞输注量（0.13 ± 0.45单位对0.31 ± 0.58单位，P = 0.028）和整个住院期间较少的红细胞输注量（0.70 ± 1.33单位对1.77 ± 2.91单位，P < 0.001）。在这个多中心倾向评分匹配队列中，与NTAR相比，TAR与较低的院内MACCE以及更有利的围手术期结局相关。需要进行前瞻性研究以确认因果关系和长期益处。
