急性心肌梗死患者急诊行冠状动脉旁路移植术后院内死亡的危险因素分析

Risk factors analysis for hospital mortality after emergency coronary artery bypass grafting in patients with acute myocardial infarction

目的分析急性心肌梗死(acute myocardial infarction,AMI)患者急诊行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后院内死亡的危险因素。方法回顾性分析2009—2019年青岛市市立医院急诊行CABG手术治疗145例AMI患者的临床资料,其中男108例(74.5%)、女37例(25.5%),平均年龄(67.7±11.5)岁。根据术后是否发生院内死亡将患者分为存活组(132例)和死亡组(13例),对术前及手术相关资料进行单因素和多因素logistic回归分析。结果术后院内死亡13例,院内死亡率为9.0%。单因素分析显示,院内死亡的影响因素为年龄≥70岁、近期心肌梗死、左室射血分数<30%、合并左主干狭窄/夹层、手术时间、同期行其它手术(P<0.05)。多因素logistic回归分析发现左室射血分数<30%[OR=2.235,95%CI(1.024,9.411),P=0.014]、近期心肌梗死[OR=4.027,95%CI(1.934,14.268),P=0.032]、手术时间[OR=1.039,95%CI(1.014,1.064),P=0.002]是紧急行CABG术后院内死亡的独立危险因素。结论AMI患者紧急行CABG获益良好,但左室射血分数<30%、近期发生心肌梗死患者院内死亡率高,应尽量缩短手术时间。

Objective To identify the risk factors for hospital mortality in patients with acute myocardial infarction(AMI)after emergency coronary artery bypass grafting(CABG).Methods We retrospectively analyzed the clinical data of 145 AMI patients undergoing emergency CABG surgery in Qingdao Municipal Hospital from 2009 to 2019.There were 108(74.5%)males and 37(25.5%)females with a mean age of 67.7±11.5 years.According to whether there was in-hospital death after surgery,the patients were divided into a survival group(132 patients)and a death group(13 patients).Preoperative and operative data were analyzed by univariate analysis,followed by multivariate logistic regression analysis,to identify the risk factors for hospital mortality.Results Over all,13 patients died in the hospital after operation,with a mortality rate of 9.0%.In univariate analysis,significant risk factors for hospital mortality were age≥70 years,recent myocardial infarction,left ventricular ejection fraction(LVEF)<30%,left main stenosis/dissection,operation time and simultaneous surgeries(P<0.05).Multivariate logistic regression analysis showed that LVEF<30%(OR=2.235,95%CI 1.024-9.411,P=0.014),recent myocardial infarction(OR=4.027,95%CI 1.934-14.268,P=0.032),operation time(OR=1.039,95%CI 1.014-1.064,P=0.002)were independent risk factors for hospital mortality after emergency CABG.Conclusion Emergency CABG in patients with AMI has good benefits,but patients with LVEF<30%and recent myocardial infarction have high in-hospital mortality,so the operation time should be shortened as much as possible.