Coronary Artery Revascularization (CARE) registry: an observational study of on-pump and off-pump coronary artery revascularization.
Coronary Artery Revascularization (CARE) registry: an observational study of on-pump and off-pump coronary artery revascularization.
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冠状动脉血运重建（CARE）登记：体外循环和非体外循环冠状动脉血运重建的观察性研究。
DOI：
10.1016/j.athoracsur.2006.10.057
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
M. Mack
中科院分区：
文献类型：
--
作者：
G. Palmer;M. Herbert;S. Prince;Janet L Williams;M. Magee;P. Brown;M. Katz;M. Mack
研究背景冠状动脉血运重建（CARE）研究是一项多中心观察性登记研究，通过经皮和外科技术进行冠状动脉血运重建。作为一个子研究，本注册表，我们分析了目前的做法和结果的体外循环和非体外循环冠状动脉旁路移植术（CABG）surgery. METHODS程序和结果数据进行了前瞻性收集的所有患者接受隔离CABG在8个社区为基础的医院在HCA医院系统2月1日至2004年7月31日。通过患者联系、电话、问卷调查和国家死亡指数获得12个月的随访结果。1251例患者接受了PCI隔离的冠状动脉血运重建术，1149例（91.8%）获得了12个月的随访数据; 654例（52.3%）患者接受了体外循环手术，597例（47.7%）患者接受了非体外循环手术。体外循环与非体外循环结果的平均移植物数量分别为3.4 ± 1与2.9 ± 1.2（p < 0.001）;手术死亡率，1.7% vs 1.7%（p = 1.00）;永久性卒中，0.9% vs 0.7%（p = 0.51）;因出血再次手术，2.6% vs 1.0%（p = 0.037）;通气时间延长，10.0% vs 3.4%（p < 0.001）;房颤，23.8% vs 14.9%（p < 0.001）;需要输血，51.0% vs 34.9%（p < 0.001）;重症监护病房住院时间，68.1 ± 97.0小时vs 59.3 ± 109.4小时（p = 0.16）;住院时间，7.5天vs 6.2天（p < 0.001）。在12个月时，体外循环与非体外循环的总心脏死亡率没有差异（4.9% vs 4.6%，p = 0.88），心肌梗死（1.0% vs 0.7%，p = 0.76），需要再次血运重建（2.8% vs 4.1%，p = 0.70）或总体主要心脏不良结局（8.7对9.4，p = 0.69）。结论：目前的冠状动脉血运重建方法由外科医生自行决定，在社区环境中差异很大，导致可接受的结果。尽管非体外循环下围手术期并发症较少，但围手术期和12个月时的死亡率相同。非体外循环组中较少的移植物似乎与疾病负担有关，而不是不完全血运重建。在12个月时，心源性死亡、心肌梗死和重复血运重建的需要相等。
BACKGROUNDThe Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery.METHODSProcedural and outcomes data were prospectively collected for all patients undergoing isolated CABG in eight community-based hospitals in the HCA Hospital System between February 1 and July 31, 2004. Twelve-month follow-up was obtained by patient contact, phone, questionnaire, and the National Death Index.RESULTSIsolated coronary artery revascularization procedures were done in 1251 patients, with 12-month follow-up data available on 1149 (91.8%); 654 patients (52.3%) were operated on-pump and 597 (47.7%) had off-pump procedures. On-pump versus off-pump results were mean number of grafts, 3.4 ± 1 versus 2.9 ± 1.2 (p < 0.001); operative mortality, 1.7% versus 1.7% (p = 1.00); permanent stroke, 0.9% versus 0.7% (p = 0.51); reoperation for bleeding, 2.6% versus 1.0% (p = 0.037); prolonged ventilation, 10.0% versus 3.4% (p < 0.001); atrial fibrillation, 23.8% versus 14.9% (p < 0.001); need for transfusion, 51.0% versus 34.9% (p < 0.001); intensive care unit length of stay, 68.1 ± 97.0 hours versus 59.3 ± 109.4 hours (p = 0.16); and hospital length of stay, 7.5 days versus 6.2 days (p < 0.001). At 12 months, there was no difference in total cardiac mortality on-pump versus off-pump (4.9% versus 4.6%, p = 0.88), myocardial infarction (1.0% versus 0.7%, p = 0.76), need for repeat revascularization (2.8% versus 4.1%, p = 0.70), or total overall major adverse cardiac outcomes (8.7 versus 9.4, p = 0.69).CONCLUSIONSCurrent approaches to coronary revascularization using both on-pump and off-pump techniques at individual surgeon discretion, which varies significantly in the community setting, leads to acceptable outcomes. Although perioperative complications were less off-pump, mortality was the same, both in the perioperative period and at 12 months. Fewer grafts in the off-pump group appeared to be related to disease burden and not incomplete revascularization. Cardiac death, myocardial infarction, and the need for repeat revascularization were equal at 12 months.