Appropriate timing of surgical intervention after transmural acute myocardial infarction
Appropriate timing of surgical intervention after transmural acute myocardial infarction
复制标题
DOI：
10.1067/mtc.2003.75
复制
发表时间：
2003-01-01
影响因子：
6
通讯作者：
Ting, W
中科院分区：
文献类型：
--
作者：
Lee, DC;Oz, MC;Ting, W
目的：急性透壁性心肌梗死后冠状动脉血运重建的推荐时间范围从立即手术干预到梗死后4周修复。这种广泛的变化在这些患者的管理中造成了困境。本研究的目的是在一个大的和当代的患者群体中描述透壁性急性心肌梗死后血运重建的最佳时机。我们对32例患者进行了回顾性多中心分析，1991年至1996年期间，纽约33家医院的179名外科医生对099名接受冠状动脉旁路移植术作为透壁性心肌梗死后唯一手术的患者进行了研究State.Results:有透壁性心肌梗死病史的所有接受冠状动脉血运重建的患者的总体住院死亡率为3.3%。随着血运重建和透壁性急性心肌梗死之间的时间间隔增加，住院死亡率降低：小于6小时、6小时至1天、1至3天、4至7天、7至14天和大于15天分别为14.2%、13.8%、7.9%、3.8%、2.9%和2.7%。43个潜在危险因素的多变量分析表明，在3天内的透壁急性心肌梗死血运重建是独立相关mortality.Conclusions：冠状动脉血运重建在3天内的透壁急性心肌梗死可能是一个额外的死亡风险。在没有紧急手术干预的绝对指征的情况下，如结构性并发症和持续缺血，应考虑手术血运重建前的3天等待期。
Objective: Recommended timing of coronary revascularization after transmural acute myocardial infarction ranges from immediate surgical intervention to repair 4 weeks after infarction. Such wide variation has created a dilemma in the management of these patients. The objective of this study was to delineate the optimal timing of revascularization after transmural acute myocardial infarction in a large and contemporary patient population.Methods: We performed a retrospective multicenter analysis of 32,099 patients who underwent coronary artery bypass grafting as the sole procedure after transmural myocardial infarction between 1991 and 1996 by 179 surgeons at 33 hospitals in New York State.Results: Overall hospital mortality for all patients who underwent coronary revascularization with a history of transmural myocardial infarction was 3.3%. Hospital mortality decreased with increasing time interval between revascularization and transmural acute myocardial infarction: 14.2%, 13.8%, 7.9%, 3.8%, 2.9%, and 2.7% for less than 6 hours, 6 hours to 1 day, 1 to 3 days, 4 to 7 days, 7 to 14 days, and greater than 15 days, respectively. Multivariate analyses of 43 potential risk factors suggests that revascularization within 3 days of transmural acute myocardial infarction is independently associated with mortality.Conclusions: Coronary revascularization within 3 days of a transmural acute myocardial infarction might be an added risk for mortality. In the absence of absolute indications for emergency surgical intervention, such as structural complications and ongoing ischemia, a 3-day waiting period before surgical revascularization should be considered.