Impact of unstable angina on outcomes of transmyocardial laser revascularization combined with coronary artery bypass grafting.
Impact of unstable angina on outcomes of transmyocardial laser revascularization combined with coronary artery bypass grafting.
复制标题
不稳定心绞痛对心肌激光血运重建联合冠状动脉旁路移植术结局的影响。
DOI：
10.1016/j.athoracsur.2005.06.020
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Edwards,FredH
中科院分区：
文献类型：
--
作者：
Horvath,KeithA;FergusonJr,TBruce;Guyton,RobertA;Edwards,FredH
研究背景对于单一的激光心肌血运重建术（TMR）治疗，不稳定型心绞痛已被证明是手术死亡率的一个重要的独立预测因子。本研究的目的是调查术前的风险状况的患者进行TMR加冠状动脉旁路移植术（CABG），并确定不稳定型心绞痛对outcome. METHODS的影响使用的社会胸外科医生国家心脏数据库从1998年至2003年，5,618例患者进行TMR加CABG。这些患者与932，715名仅接受CABG手术的患者进行了比较。（50% vs 34%），肾衰竭（7% vs 5%），外周血管疾病（20%对16%），再次手术（26%对9%），三支冠状动脉疾病（80%对71%），高脂血症（73%对62%;所有比较p < 0.001）。术前不稳定型心绞痛的发生率相似（46% vs 47%）。TMR加CABG患者的未校正围手术期死亡率为3.8%。当不稳定型心绞痛患者被移除时，观察到的TMR加CABG的死亡率降低至2.7%。结论根据术前人口统计学资料，接受TMR加CABG的患者可能具有更高的弥漫性冠状动脉疾病患病率。尽管与这种解剖结构相关的风险增加，但当将TMR添加到CABG中以提供更完全的血运重建时，死亡率并未显著增加。从单一治疗TMR的结局中可以看出，在不稳定型心绞痛患者中，TMR加CABG具有更高的风险，但这种风险与单独接受CABG治疗的患者没有显著差异。
BACKGROUNDFor sole therapy transmyocardial laser revascularization (TMR), unstable angina has been demonstrated to be a significant independent predictor of operative mortality. The objective of this study was to investigate the preoperative risk profile of patients undergoing TMR plus coronary artery bypass graft surgery (CABG) and to determine the impact of unstable angina on outcomes.METHODSUsing The Society of Thoracic Surgeons National Cardiac Database from 1998 to 2003, 5,618 patients underwent TMR plus CABG. These patients were compared with 932,715 patients who underwent CABG only operations.RESULTSThe TMR plus CABG patients had a significantly higher incidence of diabetes (50% versus 34%), renal failure (7% versus 5%), peripheral vascular disease (20% versus 16%), reoperative surgery (26% versus 9%), three-vessel coronary artery disease (80% versus 71%), hyperlipidemia (73% versus 62%; p < 0.001 for all comparisons). The incidence of preoperative unstable angina was similar (46% versus 47%). The unadjusted perioperative mortality was 3.8% for TMR plus CABG patients. When unstable angina patients were removed, the observed mortality for TMR plus CABG was decreased to 2.7%.CONCLUSIONSIt is likely that patients who undergo TMR plus CABG have a higher prevalence of diffuse coronary disease based on their preoperative demographics. Despite the increased risk associated with such anatomy, the mortality rate was not significantly increased when TMR was added to CABG in an effort to provide a more complete revascularization. As was noted from the outcomes of sole therapy TMR, in unstable angina patients, TMR plus CABG carries a higher risk, but this risk is not significantly different from that of such patients treated with CABG alone.