Early and late outcome after CABG in patients with evolving myocardial infarction
Early and late outcome after CABG in patients with evolving myocardial infarction
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DOI：
10.1016/s1010-7940(97)01169-x
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发表时间：
1997-05-01
影响因子：
3.4
通讯作者：
Meyns, B
中科院分区：
文献类型：
--
作者：
Sergeant, P;Blackstone, E;Meyns, B
目的：探讨影响进展性心肌梗死冠状动脉搭桥术（CABG）早期和晚期预后的因素。方法：269例1971年至1992年间连续行原发性或重复冠脉搭桥或进展性心肌梗死的患者。根据机构政策，这些患者被严格诊断为梗死，要么在心脏导管实验室，要么在先前的CABG后不久，要么在心脏介入治疗等候名单上。术中血流动力学稳定125例，心源性休克89例，心肺复苏55例。梗死发生和手术再灌注之间的时间间隔为53分钟至15小时（中位数为135分钟；90%为75分钟至360小时）。81例患者行乳腺内动脉移植。横断面随访100%完成，在危害函数域进行多变量分析。结果：1个月、1年、10年生存率分别为86.4%、66%。根据血流动力学分级，稳定患者的1年和10年生存率分别为98%和77%，休克患者为77%和60%，CPR患者为62%和49%。休克和心肺复苏术是早期而非晚期风险增加的危险因素。在稳定或不稳定的患者中，早期或晚期使用IMA移植物都不是一个危险因素。结论：对于发展中的心肌梗死患者，无论其血流动力学状态如何，CABG均可在可接受的早期和长期风险下进行。选择旁路输尿管对患者的生存既无不利影响，也无有利影响。血流动力学稳定的心肌梗死比st段变化的不稳定心绞痛风险小。(C) 1997爱思唯尔科学有限公司
Objective: To study the determinants of early and late outcome after coronary artery bypass grafting (CABG)for evolving myocardial infarction. Method: 269 consecutive patients underwent isolated primary or repeat CABG from 1971 to 1992 or evolving myocardial infarction. By institutional policy, these were patients, strictly diagnosed, infarcting either in the cardiac cateterization laboratory, shortly after a previous CABG, or on cardiac intervention waiting lists. At operation, 125 patients were hemodynamically stable, 89 patients in cardiogenic shock 55 patients in cardiopulmonary resuscitation (CPR). Interval between infarct onset and surgical reperfusion ranged from 53 min to 15 h (median, 135 min; 90% between 75 and 360). An internal mammary artery graft (IMA) was used in 81 patients. Cross-sectional follow-up was 100% complete and multivariable analysis was conducted in the hazard function domain. Result: One-month, 1-year and 10-year survival was 86, 84 and 66%, respectively. The 1-year and 10-year survival, stratified by hemodynamic class, was respectively 98 and 77% for the stable patients, 77 and 60% for the patients in shock and 62 and 49% for those undergoing CPR. Shock and CPR were incremental risk factors for early but not late risk. Use of an IMA graft was not a risk factor early or late in either stable or unstable patients. Conclusion: CABG can be performed with acceptable early and long-term risk in selected patients with evolving myocardial infarction, whatever their hemodynamic state. Outcome as regards survival is neither adversely or advantageously affected by choice of bypassing conduit. An evolving myocardial infarction with stable hemodynamics carries a lesser risk than an unstable anginal state with changing ST-segment. (C) 1997 Elsevier Science B.V.