非体外循环下冠状动脉旁路移植术2546例短期临床疗效和院内死亡危险因素分析

Short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting

目的探讨非体外循环下冠状动脉旁路移植术（OPCABG）短期临床疗效，分析院内死亡的术前危险因素和建立相关危险预测模型。方法本研究为回顾性研究。连续入选北京安贞医院心脏外科2014年1月至2016年1月接受OPCABG手术治疗的患者2 546例，分析可能的死亡相关危险因素，分别进行单因素分析和多因素logistic回归分析，建立相关危险预测模型，采用Hosmer-Lemeshow检验判别logistic回归模型的拟合优度。结果共2 546例患者接受OPCABG手术，院内死亡17例（0.7%）。术后二次开胸49例（1.9%），房颤380例（14.9%），肾功能衰竭3例，低心排综合征7例，胸骨感染1例，呼吸衰竭6例。多因素logistic回归分析结果提示，年龄、女性、急诊手术、左主干病变、急性心肌梗死、低左室射血分数（LVEF）、合并二尖瓣中度反流是OPCABG患者院内死亡的独立危险因素（均P＆lt;0.05）。Hosmer-Lemeshow检验χ2＝5.912，P＝0.676，受试者工作特征曲线（ROC）下面积为0.881。结论OPCABG手术短期安全有效，年龄、女性、急诊手术、左主干病变、急性心肌梗死、低LVEF、合并二尖瓣中度反流是冠心病患者OPCABG手术死亡的独立危险因素。由以上独立危险因素建立的危险预测模型具有良好的校准度和预测能力。

ObjectiveTo explore short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting （OPCABG） and establish a prediction model for in-hospital mortality. MethodsThe clinical data of patients undergoing OPCABG in Beijing Anzhen Hospital between January 2014 and January 2016 was retrospectively studied. Univariate analysis and logistic regression were applied to determine the potential risk factors, and then a prediction model for mortality was confirmed. The calibration and discrimination of the prediction model was finally tested. ResultsA total of 2 546 patients who underwent OPCABG were recruited. In-hospital mortality of OPCABG was 0.7% （17 cases）. Seven variables： female, age, left main disease 〉50%, low left ventricular ejection fraction （LVEF）, acute myocardial infarction before surgery, operative status （selective or emergent）, moderate concomitant mitral valve regurgitation were independently correlated with OPCABG mortality （all P〈0.05）. The result of Hosmer-Lemeshow test was χ2=5.912, P=0.676. The area under receiver-operating characteristic curve （ROC） was 0.881. ConclusionsOPCABG is safe and effective for myocardial revascularization in a short term. The following risk factors are associated with an increased operative mortality of OPCABG： male, age, left main disease 〉50%, low LVEF, acute myocardial infarction before surgery, operative status （selective or emergent）, moderate concomitant mitral valve regurgitation. The prediction model established by above-mentioned potential risk factors was proven to perform well by statistical tests.