Amin Daoulah, Ahmed Elmahrouk, Amr A Arafat, Badr Alzahrani, Mohammed Alshehri, Wael Qenawi, Abdelmaksoud Elganady, Wael Almahmeed, Ahmed Jamjoom, Youssef Elmahrouk, Mohammed A Qutub, Ziad Dahdouh, Nooraldaem Yousif, Omar Kanbr, Taher Hassan, Tarique Shahzad Chachar, Abdulwali Abohasan, Abdulrahman M Alqahtani, Alaa Aldossari, Mohamed Ajaz Ghani, Wael Refaat, Mohammed Balghith, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Jairam Aithal, Issam Altnji, Ehab Selim, Shahrukh Hashmani, Ahmed M Ibrahim, Reda Abuelatta, Ahmed A Ghonim, Abeer M Shawky, Osama Ahmad, Abdulaziz Alkaluf, Adnan Fathey Hussien, Mohamed N Alama, Seraj Abualnaja, Rasha Taha Baqais, Abdulkarim Alhassoun, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Amir Lotfi
{"title":"针对无保护左主干冠状动脉疾病的冠状动脉旁路移植术，术前主动脉内球囊泵对术后效果的影响。","authors":"Amin Daoulah, Ahmed Elmahrouk, Amr A Arafat, Badr Alzahrani, Mohammed Alshehri, Wael Qenawi, Abdelmaksoud Elganady, Wael Almahmeed, Ahmed Jamjoom, Youssef Elmahrouk, Mohammed A Qutub, Ziad Dahdouh, Nooraldaem Yousif, Omar Kanbr, Taher Hassan, Tarique Shahzad Chachar, Abdulwali Abohasan, Abdulrahman M Alqahtani, Alaa Aldossari, Mohamed Ajaz Ghani, Wael Refaat, Mohammed Balghith, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Jairam Aithal, Issam Altnji, Ehab Selim, Shahrukh Hashmani, Ahmed M Ibrahim, Reda Abuelatta, Ahmed A Ghonim, Abeer M Shawky, Osama Ahmad, Abdulaziz Alkaluf, Adnan Fathey Hussien, Mohamed N Alama, Seraj Abualnaja, Rasha Taha Baqais, Abdulkarim Alhassoun, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Amir Lotfi","doi":"10.21037/cdt-23-418","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) <i>vs.</i> 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] <i>vs.</i> 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) <i>vs.</i> 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) <i>vs.</i> 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) <i>vs.</i> 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) <i>vs.</i> 4 (5%), P>0.99], heart failure [5 (6.25%) <i>vs.</i> 7 (8.75%), P=0.75], MI [7 (8.75%) <i>vs.</i> 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) <i>vs.</i> 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) <i>vs.</i> 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) <i>vs.</i> 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) <i>vs.</i> 4 (IQR 2-7.5) days, P=0.01].</p><p><strong>Conclusions: </strong>Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 3","pages":"340-351"},"PeriodicalIF":2.1000,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223939/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of preoperative intra-aortic balloon pump on outcomes in coronary artery bypass grafting for unprotected left-main coronary artery disease.\",\"authors\":\"Amin Daoulah, Ahmed Elmahrouk, Amr A Arafat, Badr Alzahrani, Mohammed Alshehri, Wael Qenawi, Abdelmaksoud Elganady, Wael Almahmeed, Ahmed Jamjoom, Youssef Elmahrouk, Mohammed A Qutub, Ziad Dahdouh, Nooraldaem Yousif, Omar Kanbr, Taher Hassan, Tarique Shahzad Chachar, Abdulwali Abohasan, Abdulrahman M Alqahtani, Alaa Aldossari, Mohamed Ajaz Ghani, Wael Refaat, Mohammed Balghith, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Jairam Aithal, Issam Altnji, Ehab Selim, Shahrukh Hashmani, Ahmed M Ibrahim, Reda Abuelatta, Ahmed A Ghonim, Abeer M Shawky, Osama Ahmad, Abdulaziz Alkaluf, Adnan Fathey Hussien, Mohamed N Alama, Seraj Abualnaja, Rasha Taha Baqais, Abdulkarim Alhassoun, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Amir Lotfi\",\"doi\":\"10.21037/cdt-23-418\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE).</p><p><strong>Results: </strong>IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) <i>vs.</i> 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] <i>vs.</i> 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) <i>vs.</i> 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) <i>vs.</i> 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) <i>vs.</i> 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) <i>vs.</i> 4 (5%), P>0.99], heart failure [5 (6.25%) <i>vs.</i> 7 (8.75%), P=0.75], MI [7 (8.75%) <i>vs.</i> 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) <i>vs.</i> 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) <i>vs.</i> 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) <i>vs.</i> 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) <i>vs.</i> 4 (IQR 2-7.5) days, P=0.01].</p><p><strong>Conclusions: </strong>Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.</p>\",\"PeriodicalId\":9592,\"journal\":{\"name\":\"Cardiovascular diagnosis and therapy\",\"volume\":\"14 3\",\"pages\":\"340-351\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-06-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223939/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular diagnosis and therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/cdt-23-418\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-23-418","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：冠状动脉旁路移植术（CABG）术前使用主动脉内球囊反搏泵（IABP）可增强冠状动脉舒张期血流量，从而改善手术效果。有关冠状动脉左主干（LMCA）疾病患者术前使用 IABP 的数据很有限。本研究旨在了解因 LMCA 而接受 CABG 手术前使用 IABP 的患者的特征，并评估其对术后效果的影响：这项多中心回顾性队列研究纳入了 2015 年 1 月至 2019 年 12 月期间在 14 家三级转诊中心因未受保护的 LMCA 疾病而接受 CABG 的连续 914 例患者。根据术前植入 IABP 的情况将患者分为植入 IABP 的患者（n=101）和未植入 IABP 的患者（n=813）。根据术前变量进行倾向评分匹配，匹配比例为 1:1，匹配口径为 0.03，确定了 80 对匹配患者。倾向评分匹配的主要结果是心脏死亡率和主要不良心脑血管事件（MACCE）：结果：曾发生心肌梗死（MI）、慢性肾病、外周动脉疾病和充血性心力衰竭的患者通常会植入 IABP。IABP患者的EuroSCORE[ES>8%]更高：95 (11.86%) vs. 40 (39.60%)，Pvs. 33 (IQR 26-36)；P=0.02}。使用 IABP 的患者术前发生心源性休克和心律失常的比例更高，而未使用 IABP 的患者发生急性冠脉综合征的比例更高。配对后，各组间血管活性肌力评分无差异[3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5)，P=0.06]，使用 IABP 的患者乳酸水平明显更高[2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75)，P=0.05]。急性肾损伤[20（25%） vs. 26（32.5%），P=0.34]、脑血管意外[3（3.75%） vs. 4（5%），P>0.99]、心力衰竭[5（6.25%） vs. 7（8.75%），P=0.75]、心肌梗死[7（8.75%） vs. 8（10%），P>0.99]、主要不良心脑血管事件[10（12.5%） vs. 17（21.25%），P=0.21]和心脏病死亡率[6（7.50%） vs. 14（17.50%），P=0.09]。接受IABP的患者通气时间[8.5（IQR 6-23）小时 vs 15.5（IQR 5-50.5）小时，P=0.03]和重症监护室（ICU）停留时间[3（IQR 2-5）天 vs 4（IQR 2-7.5）天，P=0.01]更长：LMCA患者术前使用IABP可能与降低心脏死亡率或住院并发症无关。IABP 可能会延长机械通气和重症监护病房的住院时间，因此应根据每位患者的具体情况使用。
Impact of preoperative intra-aortic balloon pump on outcomes in coronary artery bypass grafting for unprotected left-main coronary artery disease.
Background: Preoperative intra-aortic balloon pump (IABP) before coronary artery bypass grafting (CABG) could improve operative outcomes by augmenting the diastolic coronary blood flow. Data on preoperative IABP use in patients with left-main coronary artery (LMCA) disease are limited. This study aimed to characterize patients who received preoperative IABP before CABG for LMCA and evaluate its effect on postoperative outcomes.
Methods: This multicenter retrospective cohort study that included consecutive 914 patients who underwent CABG for unprotected LMCA disease from January 2015 to December 2019 in 14 tertiary referral centers. Patients were grouped according to the preoperative IABP insertion into patients with IABP (n=101) and without IABP (n=813). Propensity score matching adjusting for preoperative variables, with 1:1 match and a caliber of 0.03 identified 80 matched pairs. The primary outcomes used in propensity score matching were cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE).
Results: IABP was commonly inserted in patients with previous myocardial infarction (MI), chronic kidney disease, peripheral arterial disease, and congestive heart failure. IABP patients had higher EuroSCORE [ES >8%: 95 (11.86%) vs. 40 (39.60%), P<0.001] and SYNTAX {29 [interquartile range (IQR) 25-35] vs. 33 (IQR 26-36); P=0.02} scores. Preoperative cardiogenic shock and arrhythmia were more prevalent in patients with IABP, while acute coronary syndrome was more prevalent in patients without IABP. After matching, there was no difference in vasoactive inotropic score between groups [3.5 (IQR 1-7.5) vs. 6 (IQR 1-13.5), P=0.06], and lactate levels were nonsignificantly higher in patients with IABP [2.4 (IQR 1.4-4.5) vs. 3.1 (IQR 1.05-7.75), P=0.05]. There were no differences between groups in acute kidney injury [20 (25%) vs. 26 (32.5%), P=0.34], cerebrovascular accidents [3 (3.75%) vs. 4 (5%), P>0.99], heart failure [5 (6.25%) vs. 7 (8.75%), P=0.75], MI [7 (8.75%) vs. 8 (10%), P>0.99], major adverse cardiac and cerebrovascular events [10 (12.5%) vs. 17 (21.25%), P=0.21], and cardiac mortality [6 (7.50%) vs. 14 (17.50%), P=0.09]. Patients who received IABP had longer ventilation times [8.5 (IQR 6-23) vs. 15.5 (IQR 5-50.5) h, P=0.03] and intensive care unit (ICU) stays [3 (IQR 2-5) vs. 4 (IQR 2-7.5) days, P=0.01].
Conclusions: Preoperative IABP in patients with LMCA might not be associated with reduced cardiac mortality or hospital complications. IABP could increase the duration of mechanical ventilation and ICU stay, and its use should be individualized for each patient.
期刊介绍：
The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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