Impact of Early Coronary Artery Bypass Graft in an Unselected Acute Coronary Syndrome Patient Population
Impact of Early Coronary Artery Bypass Graft in an Unselected Acute Coronary Syndrome Patient Population
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早期冠状动脉搭桥术对未选择的急性冠状动脉综合征患者群体的影响
DOI：
10.1161/circulationaha.105.001420
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发表时间：
2006
期刊：
影响因子：
37.8
通讯作者：
P. Monteiro
中科院分区：
文献类型：
--
作者：
P. Monteiro
背景-急性冠状动脉综合征（ACS）期间行冠状动脉旁路移植术（CABG）主要用于高危患者。虽然可能挽救生命，但接受早期CABG的患者传统上比不需要CABG的患者结局更差。这真的适用于一个人的身体吗？本研究的目的是评价ACS人群中，在首次住院期间进行CABG是否会影响住院结局。方法和结果-回顾性分析了自2002年以来全国范围内收治的12988例ACS患者的数据库。其中，267例患者在首次住院期间接受了CABG（A组），12721例患者未接受CABG（B组）。B组患者进一步分为2个亚组：在首次住院期间接受经皮冠状动脉介入治疗（PCI）的患者（B1组; n=3948）和未接受机械血运重建的患者（B2组; n =8773）。A组患者更常患有糖尿病、高胆固醇血症、高血压和既往心绞痛;他们也更常在入院前接受心血管药物治疗。接受CABG的患者在入院时更常处于Killip IV级（4.8% vs 1.4% vs 2.0%）;他们也接受了更多的硝酸盐和儿茶酚胺。B1组左心功能较好。A组患者更常使用机械通气和主动脉内泵，他们有更多的院内并发症（31.1% vs 18.7% vs 17.3%），即复发性心绞痛、再梗死和机械并发症。他们的冠状动脉解剖结构更严重，罪犯病变更常见于左主干（7.7% vs 0.5% vs 2.2%）。然而，他们的住院死亡率明显较低（1.1%比2.2%比6.8%; P<0.001）。多变量分析显示，早期CABG的表现是较低死亡率的独立预测因素（比值比为0.12），低分子量肝素、β受体阻滞剂和血管紧张素转换酶抑制剂的使用也是如此。结论：在因ACS而入院的冠心病患者中，尽管是在高危患者中进行早期CABG，但即使与未接受早期CABG的低风险人群的死亡率相比，也与非常低的住院死亡率相关。因此，对于符合条件的患者，应更频繁地考虑早期进行该手术。
Background— Performance of coronary artery bypass graft (CABG) during an acute coronary syndrome (ACS) is mainly used in high-risk patients. Although potentially life-saving, patients undergoing early CABG are traditionally associated with a worse outcome than those not requiring CABG. Is this really true in an unselected ACS population? The aim of this study was to evaluate, in an ACS population, if the performance of CABG during the index hospitalization influences in-hospital outcome. Methods and Results— Retrospective analysis of a nationwide database of 12 988 ACS patients admitted since 2002. Of those, 267 patients underwent CABG during the index hospitalization (group A) and 12 721 did not (group B). Group B patients were further divided in 2 subgroups: those submitted to percutaneous coronary interventions (PCI) (group B1; n=3948) during the index hospitalization and those not submitted to mechanical revascularization (group B2; n =8773). Patients from group A more frequently had diabetes, hypercholesterolemia, hypertension, and previous angina; they were also more often on cardiovascular medication before admission. Patients that underwent CABG were more often in Killip class IV at admission (4.8% versus 1.4% versus 2.0%); they also received more nitrates and catecholamines. Left ventricular function was better in group B1. Group A patients were more often on mechanical ventilation and intra-aortic pump and they had more in-hospital complications (31.1% versus 18.7% versus 17.3%), namely recurrent angina, re-infarction, and mechanical complications. They had a more severe coronary anatomy and the culprit lesion was more frequently on the left main (7.7% versus 0.5% versus 2.2%). However, their in-hospital mortality was significantly lower (1.1% versus 2.2% versus 6.8%; P<0.001). Multivariate analysis showed that performance of early CABG was an independent predictor of lower mortality (odds ratio of 0.12), as were the use of low-molecular-weight heparins, beta-blockers, and angiotensin-converting enzyme inhibitors. Conclusions— In unselected patients admitted for ACS, performance of early CABG, despite being performed in higher-risk patients, is associated with very low in-hospital mortality, even when compared with the mortality of lower-risk population not submitted to early CABG. Therefore, early performance of this procedure should be considered more often in eligible patients.