{"title":"心肌梗死后冠状动脉旁路移植手术的时机影响晚期存活率","authors":"","doi":"10.1016/j.xjon.2024.05.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.</p></div><div><h3>Methods</h3><p>We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups.</p></div><div><h3>Results</h3><p>A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; <em>P <</em> .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; <em>P =</em> .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non–ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at >7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, <em>P</em> < .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.</p></div><div><h3>Conclusions</h3><p>Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non–ST-segment elevation myocardial infarction.</p></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"20 ","pages":"Pages 40-48"},"PeriodicalIF":0.0000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666273624001281/pdfft?md5=b852b8ef74d7f9907ec44d4e6128256e&pid=1-s2.0-S2666273624001281-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Timing of coronary artery bypass grafting after myocardial infarction influences late survival\",\"authors\":\"\",\"doi\":\"10.1016/j.xjon.2024.05.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.</p></div><div><h3>Methods</h3><p>We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups.</p></div><div><h3>Results</h3><p>A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; <em>P <</em> .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; <em>P =</em> .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non–ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at >7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, <em>P</em> < .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.</p></div><div><h3>Conclusions</h3><p>Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non–ST-segment elevation myocardial infarction.</p></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"20 \",\"pages\":\"Pages 40-48\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2666273624001281/pdfft?md5=b852b8ef74d7f9907ec44d4e6128256e&pid=1-s2.0-S2666273624001281-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273624001281\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624001281","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
急性心肌梗死后冠状动脉旁路移植手术的时机对早期和晚期预后的影响仍不确定。方法我们对 1631 例连续接受孤立冠状动脉旁路移植手术的成年患者进行了回顾性研究，并了解了急性心肌梗死的时机。我们比较了急性心肌梗死后 24 小时内、急性心肌梗死后 1-7 天内和急性心肌梗死后 7 天以上接受冠状动脉旁路移植术的患者的早期和晚期死亡率。对 ST 段抬高型心肌梗死或非 ST 段抬高型心肌梗死患者及其他高危人群进行了敏感性分析。结果 共有124名患者（5.7%）在急性心肌梗死后24小时内接受了冠状动脉旁路移植术，972名患者（51.2%）在急性心肌梗死后1至7天内接受了冠状动脉旁路移植术，535名患者（43.2%）在急性心肌梗死后7天以上接受了冠状动脉旁路移植术。手术总死亡率为 2.7%，三组患者的调整后早期死亡率相当。在中位 13.5 年（四分位间范围为 8.9-17.1）的随访中，与急性心肌梗死后 1-7 天内接受冠状动脉旁路移植术的患者相比，7 天内接受冠状动脉旁路移植术的患者晚期总死亡率的调整风险更高（危险比为 1.39，95% CI，1.16-1.67；P <.001），而在 24 小时内接受冠状动脉旁路移植术的患者晚期总死亡率风险相当（危险比，1.12，95% CI，0.86-1.47；P = .39）。冠状动脉旁路移植术的时间与非 ST 段抬高型心肌梗死患者的晚期死亡率有关（7 天内接受冠状动脉旁路移植术的患者晚期死亡风险更高[危险比为 1.38，95% CI 为 1.14-1.67，P < .结论在同一住院期间，通过在 7 天内进行冠状动脉旁路移植术进行早期血管再通似乎是有益的，尤其是对于非 ST 段抬高型心肌梗死患者。
Timing of coronary artery bypass grafting after myocardial infarction influences late survival
Objectives
The role of timing of coronary artery bypass grafting after acute myocardial infarction on early and late outcomes remains uncertain.
Methods
We reviewed 1631 consecutive adult patients who underwent isolated coronary artery bypass grafting with information on timing of acute myocardial infarction. Early and late mortality were compared between patients receiving coronary artery bypass grafting within 24 hours after acute myocardial infarction, between 1 and 7 days after acute myocardial infarction, and more than 7 days after acute myocardial infarction. Sensitivity analyses were performed in subgroups of patients with ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction, and other high-risk groups.
Results
A total of 124 patients (5.7%) underwent coronary artery bypass grafting within 24 hours, 972 patients (51.2%) received coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, and 535 patients (43.2%) underwent coronary artery bypass grafting more than 7 days after acute myocardial infarction. Overall operative mortality was 2.7% with comparable adjusted early mortality among 3 groups. Over a median follow-up of 13.5 years (interquartile range, 8.9-17.1), compared with patients receiving coronary artery bypass grafting between 1 and 7 days after acute myocardial infarction, those receiving coronary artery bypass grafting at 7 days had greater adjusted risk for late overall mortality (hazard ratio, 1.39, 95% CI, 1.16-1.67; P < .001), whereas those receiving coronary artery bypass grafting within 24 hours had comparable risk of late overall mortality (hazard ratio, 1.12, 95% CI, 0.86-1.47; P = .39). Timing of coronary artery bypass grafting was associated with late mortality in patients with non–ST-segment elevation myocardial infarction (patients receiving coronary artery bypass grafting at >7 days had a higher risk of late mortality [hazard ratio, 1.38, 95% CI, 1.14-1.67, P < .001] compared with those receiving coronary artery bypass grafting between 1 and 7 days), but not in patients with ST-segment elevation myocardial infarction.
Conclusions
Early revascularization through coronary artery bypass grafting within 7 days during the same hospitalization appears beneficial, especially for patients presenting with non–ST-segment elevation myocardial infarction.
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