Timing of coronary artery bypass grafting after acute myocardial infarction may not influence mortality and readmissions
Timing of coronary artery bypass grafting after acute myocardial infarction may not influence mortality and readmissions
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DOI：
10.1016/j.jtcvs.2019.11.061
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发表时间：
2021-05-11
影响因子：
6
通讯作者：
Sultan, Ibrahim
中科院分区：
文献类型：
--
作者：
Bianco, Valentino;Kilic, Arman;Sultan, Ibrahim
目的：冠状动脉旁路移植术在急性心肌梗死后常被推迟，以避免术后并发症和死亡率的增加。我们假设急性心肌梗死后冠状动脉搭桥术的时机可能与术后结果不一致。方法：回顾2011-2017年间所有在匹兹堡大学医学中心接受单独冠状动脉搭桥术的急性心肌梗死患者。从出现心肌梗死到冠状动脉搭桥术的时间进行了对比分析，主要结果包括全因死亡率和再入院。结果：共有7048名患者接受了单独的冠状动脉搭桥术。在这些患者中，2058名患者患有急性心肌梗死，所有相关变量均可用于分析。研究人群被分成2个冠状动脉搭桥术时间队列，包括24小时以内(292例)和24小时以上(1766例)。既往经皮冠状动脉介入治疗、心源性休克和主动脉内球囊反搏在<24小时组中更为常见。低于24小时的手术死亡率显著高于对照组(7.19%vs3.79%；P=0.01)。糖尿病、外周血管疾病、血肌酐、年龄、慢性阻塞性肺疾病和免疫抑制是死亡率的显著预测因素(P<；0.05)。使用倾向评分调整风险后，不同时间队列的手术死亡率差异无统计学意义(4.15%比4.58%；P=0.62)。新发的房颤在24小时或更长的队列中发生的频率更高。两组间主要不良心脑血管事件再入院的发生率差异无统计学意义。结论：调整基线患者特征后，死亡或主要不良心脑血管事件再入院的时间队列之间无统计学差异。
Objective: Coronary artery bypass grafting is often delayed after acute myocardial infarction to avoid an increase in postoperative morbidity and mortality. We hypothesized that the timing of coronary artery bypass grafting after acute myocardial infarction may not be consistently associated with postoperative outcomes.Methods: All patients who underwent isolated coronary artery bypass grafting at the University of Pittsburgh Medical Center from 2011 to 2017 after an acute myocardial infarction were reviewed. A comparative analysis for time from myocardial infarction presentation to coronary artery bypass grafting was performed with primary outcomes including all-cause mortality and readmission.Results: A total of 7048 patients underwent isolated coronary artery bypass grafting. Of these, 2058 patients had acute myocardial infarction with all relevant variables available for analysis. The study population was divided into 2 coronary artery bypass grafting timing cohorts, including less than 24 hours (n = 292) and 24 hours or more (n = 1766). Previous percutaneous coronary intervention, cardiogenic shock, and intra-aortic balloon pump were more prevalent in the less than 24 hours group. Operative mortality was significantly higher in the less than 24 hours cohort (7.19% vs 3.79%; P = .01). Diabetes mellitus, peripheral vascular disease, serum creatinine, age, chronic obstructive pulmonary disease, and immunosuppression were significant predictors (P < .05) of mortality. After risk adjustment with propensity scoring, there was no difference between time cohorts for operative mortality (4.15% vs 4.58%; P = .62). New-onset atrial fibrillation occurred more frequently in the 24 hours or more cohort. There was no difference between groups for the occurrence of major adverse cardiovascular and cerebrovascular event readmissions.Conclusions: After adjusting for baseline patient characteristics, there was no statistically significant difference between timing cohorts for mortality or major adverse cardiovascular and cerebrovascular event readmissions.