无泵与有泵冠状动脉旁路移植术的长期临床和血管造影结果

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-03-27 DOI:10.1016/j.jss.2025.02.041

Maciej Peksa MD , Marcin Nawotka MD , Lukasz Moskal MD , Ahmed K. Awad MD , Tomasz Stankowski MD, PhD , Konrad Pieszko MD, PhD , Tomasz Zemleduch MD, PhD , Yuliia Onutska MD , Grzegorz Adamiak MD , Julia Zielska MD , Marta Miklejewska MD , Gianluca Torregrossa MD, MEBCTS , Mario Gaudino MD, PhD , Romuald Cichon MD, PhD , Sleiman Sebastian Aboul-Hassan MD, PhD

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引用次数: 0

摘要

本研究旨在比较单中心倾向匹配人群中接受非体外循环冠状动脉旁路移植术（OPCAB）和非体外循环冠状动脉旁路移植术（ONCAB）患者的长期预后。方法2010年1月至2022年6月，对2964例患者进行分析，分为两组：接受OPCAB的患者1671例（56.3%），接受ONCAB的患者1293例（43.7%）。进行倾向评分匹配，得到842对。结果在匹配的队列中，OPCAB与早期卒中发生率降低相关(优势比：0.40；95%可信区间[0.17-0.90],P = 0.02)，出血和输血再手术发生率降低。中位随访时间为6.69 y（四分位数间距为3.47 ~ 9.83 y）。OPCAB和ONCAB具有相当的长期死亡率、心肌梗死、重复血运重建术和主要的心脏和大脑不良事件。然而，与ONCAB相比，OPCAB与随访时更高的卒中自由度相关(配对配对的风险比：0.61；95%置信区间[0.39-0.95]；p = 0.015)。在匹配队列中进行了里程碑式分析，排除了前30天的随访，以排除早期卒中的影响。在具有里程碑意义的分析中，OPCAB和ONCAB在随访时具有相当的卒中自由度。简要地分析了821例2055例移植物。到血管造影的总中位时间为3.68 y（四分位数范围：1.76-6.61）。OPCAB和ONCAB在动脉移植物的通畅率（Fitzgibbon A）方面没有差异。但OPCAB组隐静脉移植通畅率高于ONCAB组（77.4% vs . 71.7%, P = 0.04）。结论sopcab与卒中发生率、出血再手术率和输血率相关。同时，在长期随访中，OPCAB和ONCAB与可比较的结果相关，包括全因死亡率、心肌梗死、重复血运重建术、主要心脏和大脑不良事件以及卒中。

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Long-Term Clinical and Angiographic Outcomes of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

Introduction

This study aimed to compare long-term outcomes in patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in a single-center propensity-matched population.

Methods

Between January 2010 and June 2022, 2964 patients were analyzed and divided into two groups: 1671 (56.3%) patients receiving OPCAB and 1293 (43.7%) patients receiving ONCAB. Propensity score matching was performed resulting in 842 pairs.

Results

In the matched cohort, OPCAB was associated with a reduced incidence of early stroke (odds ratio: 0.40; 95% confidence interval [0.17-0.90], P = 0.02) as well as a reduced incidence of reoperation for bleeding and blood transfusion. The median follow-up time was 6.69 y (interquartile range: 3.47-9.83-y). OPCAB and ONCAB had comparable long-term mortality, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebral events. However, OPCAB was associated with higher freedom from stroke at follow-up compared to ONCAB (hazard ratios stratified on matched pairs: 0.61; 95% confidence interval [0.39-0.95]; P = 0.015). A landmark analysis in the matched cohort was performed excluding the first 30 ds of follow-up to exclude the effect of early stroke. In the landmark analysis, OPCAB and ONCAB had comparable freedom from stroke at follow-up. Briefly, 821 patients with 2055 grafts were analyzed. The overall median time to angiogram was 3.68 y (interquartile range: 1.76-6.61). No difference was observed between OPCAB and ONCAB in the patency rates (Fitzgibbon A) of arterial grafts. However, the patency rate of saphenous vein graft was higher in the OPCAB group than in the ONCAB group (77.4% versus 71.7%, P = 0.04).

Conclusions

OPCAB was associated with lower rates of stroke, reoperation for bleeding, and blood product transfusion. Meanwhile, at long-term follow-up, OPCAB and ONCAB were associated with comparable outcomes, including all-cause mortality, myocardial infarction, repeat revascularization, major adverse cardiac and cerebral events, and stroke.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.