Comparison of long-term outcomes between off-pump and on-pump coronary artery bypass grafting using Japanese nationwide cardiovascular surgery database
Comparison of long-term outcomes between off-pump and on-pump coronary artery bypass grafting using Japanese nationwide cardiovascular surgery database
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使用日本全国心血管手术数据库比较非体外循环和体外循环冠状动脉旁路移植术的长期结果
DOI：
10.1007/s11748-021-01731-0
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发表时间：
2021
影响因子：
1.2
通讯作者：
N. Motomura
中科院分区：
文献类型：
--
作者：
S. Numata;Hikaru Kumamaru;H. Miyata;H. Yaku;N. Motomura
在日本，非体外循环冠状动脉搭桥术（OPCAB）比体外循环冠状动脉搭桥术更常见。OPCAB的上级早期结果已被报道;然而，长期结果仍不清楚。本研究旨在使用日本成人心血管外科数据库评价OPCAB在日本的临床结局。在2008年至2010年期间，数据库中报告了23，633例接受隔离冠状动脉搭桥术的患者。我们选择的病例来自平均每年冠状动脉手术量超过50例的医院。在41家机构的总计7724例病例中，纳入了2150例（31.2%）体外循环冠状动脉搭桥（ONCAB）和5574例（68.8%）OPCAB病例。使用根据患者特征和术前因素开发的PS进行倾向评分（PS）匹配，得到2007例匹配病例。收集患者死亡率和卒中的长期随访数据。OPCAB的住院死亡率显著较低（ONCAB 1.1%，OPCAB 0.4% p = 0.01）。OPCAB组卒中发生率较低（ONCAB 1.7%，OPCAB 0.8%，p = 0.01）。OPCAB和ONCAB之间的7年总生存率（分别为86.1%和88.1%）、复合结局（分别为72.0%和73.9%）或心源性死亡（分别为97.3%和97.1%）无统计学显著差异。亚组分析（> 75岁）显示OPCAB组的趋势更差。仅OPCAB组血运重建不完全显著影响7年生存率。OPCAB与早期预后获益相关;然而，当患者年龄较大或血运重建不完全时，其长期结局可能不太有利。
In Japan, off-pump coronary artery bypass (OPCAB) is more common than on-pump coronary artery bypass. Superior early results of OPCAB have been reported; however, long-term results were still unclear. Purpose of this study is to evaluate the clinical outcomes of OPCAB in Japan using Japan Adult Cardiovascular Surgery Database. Between 2008 and 2010, 23,633 patients who underwent isolated coronary artery bypass were reported in database. We selected the cases from the hospital with mean annual coronary surgery volume of more than 50. Among the total of 7724 cases at 41 institutions, 2150 (31.2%) on-pump coronary artery bypass (ONCAB) and 5574 (68.8%) OPCAB cases were included. Propensity score (PS) matching was performed using PS developed from patient characteristics and preoperative factors resulting in 2007 cases matched pairs. Long-term follow-up data on patients’ mortality and stroke were collected. In-hospital mortality was significantly lower in OPCAB (ONCAB 1.1%, OPCAB 0.4% p = 0.01). Stroke was low in OPCAB group (ONCAB 1.7%, OPCAB 0.8%, p = 0.01). There was no statistically significant difference between OPCAB and ONCAB regarding 7-year overall survival (86.1% vs 88.1% respectively), composite outcomes (72.0% vs 73.9% respectively), or cardiac deaths (97.3% vs 97.1% respectively). Subgroup analysis (more than 75 years old) showed a worse trend in OPCAB group. Only in OPCAB group, incomplete revascularization significantly influenced 7-year survival. OPCAB is associated with early prognostic benefits; however, it might be less favorable outcomes in the long term when patients are older or with incomplete revascularization.
影响因子：
45.3
作者：
Uno, Hajime;Claggett, Brian;Wei, Lee-Jen
通讯作者：
Wei, Lee-Jen