Sergeant P, Blackstone E, Meyns B
Cardiac Surgery Department, Gasthuisberg University Hospital Leuven, Belgium.
Eur J Cardiothorac Surg. 1997 May;11(5):848-56. doi: 10.1016/s1010-7940(97)01169-x.
To study the determinants of early and late outcome after coronary artery bypass grafting (CABG) for evolving myocardial infarction.
269 consecutive patients underwent isolated primary or repeat CABG from 1971 to 1992 for evolving myocardial infarction. By institutional policy, these were patients, strictly diagnosed, infarcting either in the cardiac cateterization laboratory, shortly after a previous CABG, or on cardiac intervention waiting lists. At operation, 125 patients were hemodynamically stable, 89 patients in cardiogenic shock 55 patients in cardiopulmonary resuscitation (CPR). Interval between infarct onset and surgical reperfusion ranged from 53 min to 15 h (median, 135 min; 90% between 75 and 360). An internal mammary artery graft (IMA) was used in 81 patients. Cross-sectional follow-up was 100% complete and multivariable analysis was conducted in the hazard function domain.
One-month, 1-year and 10-year survival was 86, 84 and 66%, respectively. The 1-year and 10-year survival, stratified by hemodynamic class, was respectively 98 and 77% for the stable patients, 77 and 60% for the patients in shock and 62 and 49% for those undergoing CPR. Shock and CPR were incremental risk factors for early but not late risk. Use of an IMA graft was not a risk factor early or late in either stable or unstable patients.
CABG can be performed with acceptable early and long-term risk in selected patients with evolving myocardial infarction, whatever their hemodynamic state. Outcome as regards survival is neither adversely or advantageously affected by choice of bypassing conduit. An evolving myocardial infarction with stable hemodynamics carries a lesser risk than an unstable anginal state with changing ST-segment.
研究急性心肌梗死患者冠状动脉旁路移植术（CABG）早期和晚期预后的决定因素。
1971年至1992年间，269例连续性患者因急性心肌梗死接受单纯初次或再次CABG。根据机构政策，这些患者均经严格诊断，要么在心脏导管实验室发生梗死，要么在先前CABG后不久，要么在心脏介入等待名单上。手术时，125例患者血流动力学稳定，89例患者发生心源性休克，55例患者进行心肺复苏（CPR）。梗死发作至手术再灌注的时间间隔为53分钟至15小时（中位数为135分钟；90%在75至360分钟之间）。81例患者使用了乳内动脉移植物（IMA）。横断面随访100%完成，并在风险函数领域进行多变量分析。
1个月、1年和10年生存率分别为86%、84%和66%。按血流动力学分级分层的1年和10年生存率，稳定患者分别为98%和77%，休克患者分别为77%和60%，接受CPR的患者分别为62%和49%。休克和CPR是早期而非晚期风险的递增危险因素。在稳定或不稳定患者中，使用IMA移植物在早期或晚期均不是危险因素。
对于选定的急性心肌梗死患者，无论其血流动力学状态如何，CABG均可在可接受的早期和长期风险下进行。生存结局不受旁路移植管道选择的不利或有利影响。血流动力学稳定的急性心肌梗死患者的风险低于ST段改变的不稳定心绞痛患者。
