早期冠状动脉旁路移植术对高危急性非ST段抬高型心肌梗死患者12个月临床结果的影响  

Effect of early coronary artery bypass grafting on 12 months clinical outcomes in patients with high risk acute non-ST segment elevation myocardial infarction

作　　者：武凌宁 徐承义[2] 熊晡 刘成伟[2] 苏晞[2] 王波[3] 陈绪发[3] WU Ling-ning;XU Cheng-yi;XIONG bu;LIU Cheng-wei;SU Xi;WANG Bo;CHEN Xu-fa(Huangshi Youse Hospital,Huangshi 435005,China;Cardiology Depatment Wuhan Asia Heart Hospital,Wuhan 430022,China;Cardiac Surgery,Wuhan Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]黄石有色医院心内科,湖北省黄石市435005 [2]武汉亚洲心脏病医院心内科,湖北省黄石市435005 [3]武汉亚洲心脏病医院心外科,湖北省黄石市435005

出　　处：《中国心血管病研究》2021年第6期516-520,共5页Chinese Journal of Cardiovascular Research

基　　金：武汉市科委课题项目(WX15C02)。

摘　　要：目的探讨早期冠状动脉旁路移植术(CABG)干预高危急性非ST段抬高型心肌梗死(NSTEMI)的可行性。方法收集2018年1月1日至12月31日在武汉亚洲心脏病医院行CABG治疗的高危NSTEMI患者178例。所有患者均在确诊后24 h内行冠状动脉造影检查,再1∶1随机分组,根据确诊至行CABG时间分为研究组(<72 h,n=87)和对照组(>72 h,n=91)。主要终点是12个月随访主要不良心血管事件(MACE)的发生率(全因死亡、非计划血运重建、再发心肌梗死以及卒中)。结果两组12个月MACCE发生率相似,研究组19.5%,对照组17.6%(χ^(2)=0.113,P=0.737)。其中,研究组12个月全因死亡率高于对照组,但差异无统计学意义(9.2%比7.7%,χ^(2)=0.130,P=0.718)。将全部患者纳入回归分析,结果显示欧洲心脏外科手术风险评估(EuroSCORE)Ⅱ是预测全因死亡事件的独立危险因素(OR=1.216,95%CI 1.002~1.518,P=0.039)。结论高危NSTEMI患者行早期外科血运重建死亡率高,但与延迟策略比较并无统计学差异。EuroSCOREⅡ是预测全因死亡事件的独立危险因素。Objective To investigate the feasibility of early coronary artery bypass(CABG)intervention in high-risk acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods 178 high-risk NSTEMI patients treated with CABG were enrolled between Jauary and December 2018 in Wuhan Asia Heart Hospital.All the patients were arranged for coronary angiography within 24 h after confirmed diagnosis,and then divided into two groups randomly according to the time point of CABG after confirmed diagnosis(study group:<72 h,n=87),control group:>72 h,n=91.The primary endpoints was 12-month incidence of MACE(all-cause death,unplanned revascularization,recurrent myocardial infarction and stroke).Results Incidence of 12-month MACCE was similar in both groups(study group 19.5%vs.17.6%control group,χ^(2)=0.113,P=0.737);in particular,the mortality in study group was higher than control group but with no statistical difference(9.2%vs.7.7%,χ^(2)=0.130,P=0.718).Regression analysis showed that the independent risk factors for mortality in the entire cohort was european system for cardiac operative risk evaluation(EuroSCORE)Ⅱ(OR=1.216,95%CI 1.002~1.518,P=0.039).Conclusions Early revascularization for the high-risk NSTEMI patients shows a higher mortality,which is comparable to that following delayed revascularization.EuroSCOREⅡis determined as an independent risk factor for the mortality.

关 键 词：早期血运重建 延迟血运重建 急性非ST段抬高型心肌梗死 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]