Braxton J H, Hammond G L, Letsou G V, Franco K L, Kopf G S, Elefteriades J A, Baldwin J C
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn 06520, USA.
Circulation. 1995 Nov 1;92(9 Suppl):II66-8. doi: 10.1161/01.cir.92.9.66.
To assess optimal timing for coronary artery bypass graft surgery (CABG) after an acute myocardial infarction (AMI), all patients undergoing CABG without associated procedures at our institution from January 1, 1991, to July 30, 1992, were reviewed. Patients were divided into three groups based on time from infarct to revascularization. The control group consisted of patients operated on for angina refractory to medical management. Relative risks (incident infarction group divided by incident control group) were established for need of vasopressors, new balloon to separate from bypass, perioperative myocardial infarction, and hospital mortality.
One hundred sixteen patients underwent CABG within 6 weeks of infarction. In the experimental group, 58 patients underwent CABG for non-Q-wave infarction, and 58 patients underwent CABG for Q-wave infarction. In the control group, 255 patients underwent surgery for angina without infarction. Patients were analyzed by group relative to the time between infarction and CABG. Patients were analyzed between infarction and CABG and assigned to one of three groups. Group 1 patients were revascularized within 48 hours; group 2, between 3 and 5 days; and group 3, after 5 days. Significance was determined by Fisher's exact or Mantel-Haenszel chi 2 test where appropriate. Multivariate analysis was performed on statistics that were significant. All patients within all groups after Q-wave or non-Q-wave myocardial infarction had a significantly higher risk of needing an intra-aortic balloon pump and vasopressors to be weaned from bypass and a greater incidence of perioperative MI compared with control patients. Surgical mortality is highest immediately after Q-wave infarctions.
Patients with non-Q-wave infarction may undergo CABG relatively safely at any time. Acceptable timing for CABG after Q-wave infarction is after 48 hours.
为评估急性心肌梗死（AMI）后冠状动脉旁路移植术（CABG）的最佳时机，我们回顾了1991年1月1日至1992年7月30日在我院接受CABG且无相关手术的所有患者。根据从梗死到血运重建的时间将患者分为三组。对照组由因药物治疗无效的心绞痛而接受手术的患者组成。确定了血管升压药需求、新球囊与旁路分离、围手术期心肌梗死和医院死亡率的相对风险（梗死事件组除以对照事件组）。
116例患者在梗死6周内接受了CABG。在实验组中，58例患者因非Q波梗死接受CABG，58例患者因Q波梗死接受CABG。在对照组中，255例患者因心绞痛而无梗死接受手术。根据梗死与CABG之间的时间对患者进行分组分析。在梗死与CABG之间对患者进行分析，并将其分为三组之一。第1组患者在48小时内进行血运重建；第2组在3至5天之间；第3组在5天后。在适当情况下，通过Fisher精确检验或Mantel-Haenszel卡方检验确定显著性。对具有显著性的统计数据进行多变量分析。与对照组患者相比，所有组中Q波或非Q波心肌梗死后的所有患者需要主动脉内球囊泵和血管升压药以脱离旁路的风险显著更高，围手术期心肌梗死的发生率更高。Q波梗死后立即手术死亡率最高。
非Q波梗死患者可在任何时间相对安全地接受CABG。Q波梗死后CABG的可接受时机是在48小时后。
