经皮冠状动脉介入史对冠状动脉旁路移植术结果影响的多中心临床研究

Influence of prior percutaneous coronary intervention on outcome of coronary artery bypass grafting:A multi-center clinical study

目的探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)史对冠状动脉旁路移植术(coronary artery bypass grafting,CABG)疗效的影响。方法回顾性分析江苏省CABG多中心注册登记数据库内2016—2019年行首次单纯择期CABG 5216例患者的临床资料。根据患者是否接受过PCI治疗,分为PCI组(673例)和non-PCI组(4543例)。其中PCI组男491例、女182例,年龄(62.6±8.2)岁;non-PCI组男3335例、女1208例,年龄(63.7±8.7)岁。采用多因素logistic回归分析方法及倾向性评分匹配,比较两组30 d死亡率、主要并发症发生率以及术后1年随访结果。结果倾向性评分匹配前及匹配后,PCI组和non-PCI组术后30 d死亡率[14例(2.1%)vs.77例(1.7%),P=0.579;14例(2.1%)vs.11例(1.6%),P=0.686]和主要并发症(心肌梗死、脑卒中、机械辅助通气≥24 h、新发肾功能衰竭透析、纵隔感染以及心房颤动)发生率差异均无统计学意义(P均>0.05)。匹配前后,PCI组出血再次开胸止血的比例均显著高于non-PCI组[19例(2.8%)vs.67例(1.5%),P=0.016;19例(2.8%)vs.7例(1.0%),P=0.029]。术后随访结果显示,匹配前后PCI组和non-PCI组1年生存率差异均无统计学意义[613例(93.1%)vs.4225例(94.6%),P=0.119;613例(93.1%)vs.630例(95.2%),P=0.124]。匹配前后PCI组再次心源性入院率较non-PCI组显著增高[32例(4.9%)vs.113例(2.5%),P=0.001;32例(4.9%)vs.17例(2.6%),P=0.040]。结论PCI史不显著增加CABG围术期死亡率及主要并发症发生率,但增加术后1年再次心源性入院率。

Objective To investigate the influence of prior percutaneous coronary intervention(PCI)on the outcome of coronary artery bypass grafting(CABG).Methods Clinical data of 5216 patients from Jiangsu Province CABG registry who underwent primary isolated CABG from 2016 to 2019 were retrospectively analyzed.Patients were divided into a PCI group(n=673)and a non-PCI group(n=4543)according to whether they had received PCI treatment.The PCI group included 491 males and 182 females,aged 62.6±8.2 years,and the non-PCI group included 3335 males and1208 females,aged 63.7±8.7 years.Multivariable logistic regression and propensity score matching(PSM)were used to compare 30-day mortality,incidence of major complications and 1-year follow-up outcomes between the two groups.Results Both in original cohort and matched cohort,there was no statistical difference in the 30-day mortality[14(2.1%)vs.77(1.7%),P=0.579;14(2.1%)vs.11(1.6%),P=0.686],or the incidence of major complications(myocardial infarction,stroke,mechanical ventilation≥24 h,dialysis for new-onset renal failure,deep sternal wound infection and atrial fibrillation)(all P>0.05).The rate of reoperation for bleeding in the PCI group was higher than that in the non-PCI group[19(2.8%)vs.67(1.5%),P=0.016;19(2.8%)vs.7(1.0%),P=0.029].Both in original cohort and matched cohort,there was no statistical difference in 1-year survival rate between the two groups[613(93.1%)vs.4225(94.6%),P=0.119;613(93.1%)vs.630(95.2%),P=0.124],while the re-admission rate in the PCI group was significantly higher than that in the non-PCI group[32(4.9%)vs.113(2.5%),P=0.001;32(4.9%)vs.17(2.6%),P=0.040].Conclusion This study shows that a history of PCI treatment does not significantly increase the perioperative mortality and major complications of CABG,but increases the rate of cardiogenic re-admission 1 year postoperatively.