摘要
背景:本研究旨在比较心脏不停跳与常规的冠状动脉搭桥(CABG)方法治疗急诊指征下的急性冠状动脉综合征的效果。方法和结果:评价了2000年1月至2005年9月638例通过胸骨正中切口行急诊CABG的急性冠状动脉综合征(ACS)患者。用倾向性评分分析预测患者接受不停跳(BH)(n=240)或心脏停跳(CA)(n=398)方案的可能性。531例患者的血流动力学稳定,107例患者出现了心源性休克(CS)。
BACKGROUND -Aim of this study was to compare the outcome of beating heart versus conventional coronary artery bypass graft(CABG) strategies in acute coronary syndromes for emergency indications. METHODS AND RESULTS -638 consecutive patients with acute coronary syndrome(ACS) receiving emergency CABG surgery via midline sternotomy from January 2000 to September 2005 were evaluated. Propensity score analysis was used to predict the probability of undergoing beating heart(BH)(n=240) versus cardioplegic cardiac arrest(CA)(n=398) strategies. Patients presented with stable hemodynamics(n=531) or in cardiogenic shock(CS)(n=107). Hospital and follow-up outcome was compared by propensity score adjusted multiregression analysis. BH included 116 on-pump and 124 off-pump(OPCAB) procedures. There was a propensity to operate CS patients on the beating heart(multivariate odds ratio[OR], 3.8; P=0.001). Under stable hemodynamics significant predictors for BH selection were logEuro SCORE >20%(OR, 2.05), creatinine >1.8 mg/dL(OR, 4.12), complicated percutaneous coronary intervention(OR, 1.88), ejection fraction< 30%(OR, 2.64), whereas left main disease(OR, 0.68), circumflex artery(OR, 0.32), and 3-vessel disease(OR, 0.67) indicated preference for cardioplegic arrest. Time from skin incision to culprit lesion revascularization was significantly reduced in BH patients. BH surgery led to a significant benefit in terms of less drainage loss, less transfusion requirement, less inotropic support, shorter ventilation time, lower stroke rate, and shorter intensive care unit stay. In CS, BH was associated with lower incidence of stroke, inotropic support, acute renal failure, new atrial fibrillation and sternal wound healing complications. In CS patients, hospital mortality rate was reduced when using beating heart strategies(P=0.048). Overall survival, major adverse cerebral and cardiovascular event rate, and repeated revascularization was comparable during a 5-year follow-up. CONCLUSIONS -Beating heart strategies are associated with an improved hospital outcome and comparable long-term results for high-risk patients presenting acute coronary syndrome with or without CS.
