他汀类药物与非体外循环冠状动脉旁路移植术后新发脑梗塞关联性分析

Association between statins with new-onset cerebral infarction after off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉旁路移植术(OPCABG)治疗冠状动脉粥样硬化性心脏病(CAD)患者, 术前使用他汀类药物能否有效降低术后新发脑梗塞发生风险。方法回顾性纳入2019年2月至2023年3月在北京安贞医院心脏外科行OPCABG的7 407例CAD患者, 其中男5 559例, 女1 848例;年龄26~92岁, 中位年龄63岁。高血压5 536例(74.7%)是最常见的合并症, 其次是高脂血症4 261例(57.5%)和2型糖尿病2 941例(39.7%)。依据术前是否使用他汀类药物分为他汀组(5 586例, 75.4%)和对照组(1 821例, 24.6%)。采用逆处理概率加权(IPTW)校正其他危险因素, 分析组间比值比(OR)和95%置信区间(CI), 评估两组患者术后新发脑梗塞风险差异。结果共有346例(4.7%)患者在OPCABG后出现了新发脑梗塞。经IPTW校正后, 他汀组OPCABG术后新发脑梗塞的发生率显著低于对照组(4.3%对6.8%, OR=0.62, 95%CI:0.53~0.72, P<0.001), 术后急性肾损伤的发生率也低于对照组(10.4%对13.4%, OR=0.75, 95%CI:0.67~0.94, P<0.001)。两组患者的术后肝损伤、术后心房颤动、二次开胸率、术后体外膜肺氧合和主动脉内气囊反搏使用率、住院期间病死率差异均无统计学意义(P>0.05)。亚组分析结果显示, 无论患者术前是否有高脂血症, 低密度脂蛋白胆固醇(LDL-C)水平是否达标, 术前应用他汀类药物均能有效降低患者术后脑梗塞发生率(P<0.05)。结论他汀组药物能显著降低OPCABG术后新发脑梗塞的风险。无论患者术前是否存在高脂血症, 基线LDL-C是否达标, 术前使用他汀类药物均能有效降低术后新发脑梗塞的发生风险。

Objective:To explore whether the preoperative use of statins in patients with coronary atherosclerotic heart disease(CAD)undergoing off-pump coronary artery bypass grafting(OPCABG)can effectively reduce the risk of postoperative new-onset cerebral infarction.Methods:A retrospective study was conducted on 7407 CAD patients who underwent OPCABG in the Department of Cardiac Surgery,Beijing Anzhen Hospital,from February 2019 to March 2023.Among them,5559 were males and 1848 were females,with an age range of 26 to 92 years and a median age of 63 years.Hypertension(5536 cases,74.7%)was the most common comorbidity,followed by hyperlipidemia(4261 cases,57.5%)and type 2 diabetes mellitus(2941 cases,39.7%).The patients were divided into the statin group(5586 cases,75.4%)and the control group(1821 cases,24.6%)based on whether statins were used preoperatively.The inverse probability treatment weighting(IPTW)method was applied to adjust other risk factors,and the odds ratio(OR)and 95%confidence interval(CI)were reported to assess the difference in the risk of postoperative new-onset cerebral infarction between the two groups.Results:A total of 346 patients(4.7%)developed new-onset cerebral infarction after OPCABG.After IPTW adjustment,the incidence of cerebral infarction was significantly lower in the statin group compared to the control group(4.3%vs.6.8%,OR=0.62,95%CI:0.53-0.72,P<0.001),and the incidence of postoperative acute kidney injury(AKI)was also lower in the statin group(10.4%vs.13.4%,OR=0.75,95%CI:0.67-0.94,P<0.001).No statistically significant differences were observed between the two groups in terms of postoperative liver injury,postoperative atrial fibrillation,re-thoracotomy rate,use of extracorporeal membrane oxygenation and intra-aortic balloon pump,or in-hospital mortality(P>0.05).Regardless of whether patients had preoperative hyperlipidemia or whether their low-density lipoprotein cholesterol(LDL-C)levels were within the target range,preoperative statin use effectively reduced the risk of postoperative new-onset cerebral infarction(P<0.05).Conclusion:Statin therapy can significantly reduce the risk of postoperative new-onset cerebral infarction after OPCABG.Preoperative statin use is effective in lowering this risk,regardless of the presence of preoperative hyperlipidemia or whether baseline LDL-C levels are within the target range.