青年急性心肌梗死患者行冠状动脉旁路移植术的临床效果

Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction

目的探讨45岁以下合并急性心肌梗死(AMI)的冠状动脉粥样硬化性心脏病(冠心病)患者行冠状动脉旁路移植术(CABG)的围术期效果及中远期预后。方法采集自2010年5月至2018年5月首都医科大学附属北京安贞医院596例45岁以下行CABG青年冠心病患者的临床资料,AMI组中男性患者234例、平均年龄(41.59±3.79)岁;女性患者26例、平均年龄(41.64±3.03)岁。心绞痛组中男性患者280例、平均年龄(42.19±2.90)岁;女性患者56例、平均年龄(41.54±3.52)岁。比较两组临床效果。结果两组患者术前基线资料差异无统计学意义。全组患者在院死亡7例,总体死亡率为1.23%。AMI组260例、死亡4例;心绞痛组336例、死亡3例,两组围术期死亡率差异(1.54%vs.0.89%,P=0.477)无统计学意义。术后二次开胸止血、新发脑梗、急性肾功能衰竭、新发心房颤动等并发症的发生率差异均无统计学意义(P>0.05)。急性心梗组呼吸机使用时间、ICU治疗时间及住院费用长于或高于心绞痛组[(22.54±22.31)h vs.(18.64±11.81)h,(30.66±27.46))h vs.(23.96±15.11)h,(97 186±33 741)￥vs.(90 081±24 537)￥,P<0.05]。ST段抬高型心肌梗死与非ST段抬高型心肌梗死两亚组间院死亡率和围术期并发症的发生率差异无统计学意义(P>0.05)。术后随访546例,随访率92.6%。中位随访时间4(0.5,8.5)年,全因死亡21例(3.85%),72.2%患者免于主要不良心血管事件(MACCE)。两组间MACCE、全因死亡、再发心绞痛发生和脑卒中发生率差异无统计学意义,AMI组再次心肌梗死及再次行PCI率高于心绞痛组(P<0.05)。结论45岁以下合并急性心肌梗死的冠心病患者行CABG的早期临床效果安全可靠,中远期随访结果令人满意。

Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG)in acute myocardial infarction(AMI)patients with coronary artery disease(CAD)(age≤45 years).Methods Data of 596 adult CAD patients(include AMI and Angina)who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018.In an AMI group,234 were male patients with an average age of 41.59±3.79 years;26 were female patients with an average age of 41.64±3.03 years.In an angina group,280 were male patients with an average age of 42.19±2.90 years;56 were female patients with an average age of 41.54±3.52 years.Preoperative baseline variables,perioperative mortality,major adverse cardiac and cerebrovascular events(MACCE)were compared between two group.Results There was no significant difference in all preoperative variables.Seven patients were died and the hospital mortality rate was 1.23%(1.54%vs.0.89%,P=0.477).The complications including reoperation for bleeding,cerebral infarction,renal failure and atrial fibrillation arrhythm ia were w ithout significant difference between two group(P>0.05).The intensive care unit stay duration(30.66±27.46 h vs.23.96±15.11 h),intubation duration(22.54±22.31 h vs.18.64±11.81 h)and hospitalization costs(97 186±33 741￥vs.90 081±24 537￥,P=0.003)were greater in the AMI group.The hospital mortality rate and complications rate were without significant difference between STEMI(ST segment elevated myocardial infarction)and NSTEMI(non-ST-segment elevated myocardial infarction)subgroups(P>0.05).The follow-up rate was 92.6%(546 patients)and the follow-up time was 4(0.5 to 8.5)years.All cause-mortality rate was 3.85%(21 patients),and freedom MACCE was 72.2%.The freedom from MACCE,recurred angina and cerebral infarction were without significant difference,but AMI was associated with higher rate of PCI procedure.Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.