Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting.
Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting.
复制标题
冠状动脉左主干狭窄是非体外循环冠状动脉旁路移植术的另一个危险因素。
DOI：
10.1016/j.jtcvs.2011.05.005
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Pi
中科院分区：
文献类型：
--
作者：
Hui;Jian;Wei Xiao;Shuang Zhao;F. Huang;C. Gu;Chun;Pi
背景我们的目的是确定相对于非左主干冠状动脉狭窄，一般冠状动脉左主干狭窄（LMS）和开口LMS是否会在非体外循环冠状动脉旁路移植术（CABG）后带来额外的风险。方法从2008年1月1日至2009年12月31日，4366例患者在北京安贞医院接受了初次孤立非体外循环CABG。疾病回顾性地分为非左主干疾病 (n = 3523)、非孔口 LMS (n = 765) 和孔口 LMS (n = 78)。各组进行倾向评分匹配。计算了 Kaplan-Meier 免于主要不良心脑血管事件 (MACCE) 的风险。 结果在术后前 30 天，孔口 LMS 组的死亡率 (6.41%) 显着高于非左主干疾病组 (0.855%，χ2=7.78，P=.005) 和非孔口 LMS 组 (1.28%，χ2=4.71， P = .03) 组。口 LMS 组 (20.5%) 的 MACCE 发生率显着高于非左主干疾病组 (5.98%, P = .000) 和非口 LMS 组 (9.62%, P = .002)。口 LMS 与非左主干疾病的早期 MACCE 的优势比为 3.74（95% 置信区间，1.72-8.17）。在平均随访 12.8 ± 7.5 个月和累积随访 498.5 患者年时，组间无 MACCE 的差异未达到统计学显着性 (χ2= 2.39，P = .303)。 结论：sstial LMS 在非体外循环 CABG 中带来额外的早期死亡和 MACCE 风险。 LMS 口的非体外循环 CABG 应该进行更多的术中监测并降低转换为体外循环 CABG 的阈值。
BACKGROUNDOur aim was to determine whether general left main coronary artery stenosis (LMS) and ostial LMS pose additional risks after off-pump coronary artery bypass grafting (CABG) relative to non–left main coronary artery stenosis.METHODSFrom January 1, 2008, to December 31, 2009, 4366 patients underwent primary isolated off-pump CABG at Beijing Anzhen Hospital. Disease was retrospectively classified as non–left main disease (n = 3523), nonostial LMS (n = 765), and ostial LMS (n = 78). Groups were propensity score matched. Kaplan-Meier freedoms from major adverse cardiac and cerebrovascular events (MACCEs) were calculated.RESULTSDuring the first 30 postoperative days, mortality was significantly higher in the ostial LMS group (6.41%) than in non–left main disease (0.855%, χ2= 7.78, P = .005) and nonostial LMS (1.28%, χ2= 4.71, P = .03) groups. Incidence of MACCEs was significantly higher in the ostial LMS group (20.5%) than in non–left main disease (5.98%, P = .000) and nonostial LMS (9.62%, P = .002) groups. Odds ratio for early MACCEs of ostial LMS versus non–left main disease was 3.74 (95% confidence interval, 1.72–8.17). At mean follow-up 12.8 ± 7.5 months and cumulative follow-up 498.5 patient-years, difference among groups in freedom from MACCEs did not reach statistical significance (χ2= 2.39, P = .303).CONCLUSIONSOstial LMS poses additional early risks of mortality and MACCEs in off-pump CABG. Off-pump CABG for ostial LMS should proceed with greater of intraoperative surveillance and lower threshold for converting to on-pump CABG.
影响因子：
158.5
作者：
Serruys, Patrick W.;Morice, Marie-Claude;Mohr, Friedrich W.
通讯作者：
Mohr, Friedrich W.