上海交通大学学报(医学版) ›› 2017, Vol. 37 ›› Issue (12): 1658-.doi: 10.3969/j.issn.1674-8115.2017.12.014

• 论著(临床研究) • 上一篇    下一篇

多支与单支动脉桥非体外冠状动脉旁路移植术的中远期疗效  ——倾向性评分匹配对比研究

朱鹏雄,陈安清,刘俊,王哲,叶晓峰,周密,赵强   

  1. 上海交通大学  医学院附属瑞金医院心脏外科,上海  200025
  • 出版日期:2017-12-28 发布日期:2018-01-10
  • 通讯作者: 赵强,电子信箱:zq11607@rjh.com.cn
  • 作者简介:朱鹏雄(1992—),男,博士生;电子信箱:pengxiongzhu@me.com
  • 基金资助:
    上海市卫生和计划生育委员会面上项目(201540205)

Clinical results of multi-artery-graft and single-artery-graft off-pump coronary artery bypass grafting: a propensity score matching follow-up study#br#

ZHU Peng-xiong, CHEN An-qing, LIU Jun, WANG Zhe, YE Xiao-feng, ZHOU Mi, ZHAO Qiang   

  1. Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025
  • Online:2017-12-28 Published:2018-01-10
  • Supported by:
     Foundation of Health and Family Planning Commission of Shanghai Municipality, 201540205

摘要:  目的 · 利用倾向性评分匹配平衡多支与单支动脉桥非体外冠状动脉旁路移植术(OPCABG)的混杂因素,评价两者在处理左主 干及多支冠状动脉病变中的效果。方法 · 纳入 2012 年 1 月至 2016 年 9 月在上海交通大学医学院附属瑞金医院行单纯 OPCAB 术的左 主干及多支病变患者共 1 578 例,对 2 组患者进行倾向性评分匹配得到风险调整后的临床结果,通过 Kaplan-Meier 曲线分析 2 组免于 主要不良心脑血管事件(MACCE)与免于因心脏疾患再次入院的生存情况,最后通过 Cox 回归模型分析 MACCE 发生的独立危险因 素。结果 · 平均随访时间为 28 个月(7 ~ 55 个月)。经倾向性评分匹配后,2 组患者在各项院内短期临床终点上差异均无统计学意义。 在中远期随访结果中,多支动脉桥组的因心脏疾患再次入院率(2.7% vs 12.7%,P=0.023)、 CCS 分级(1.2±0.4 vs 1.4±0.6,P=0.020) 及术后 1 年桥血管通畅率(95.8% vs 85.9%,P=0.025)均显著优于对照组,而其余终点均无显著性差异。多支动脉桥组免于因心脏疾 患再次入院的生存情况显著改善(P=0.028)。性别为女性是中远期MACCE 的独立危险因素(95% CI 为 0.117 ~ 0.906,P=0.032)。 结论 · 使用多支动脉桥 OPCABG 处理左主干及多支冠状动脉病变是一种安全的手术方式,改善术后桥血管通畅率,具有一定的中远 期临床获益;女性患者术后的随访应得到进一步的重视。

关键词: 多支动脉桥, 非体外冠状动脉旁路移植术, 倾向性评分匹配

Abstract:

Objective · To explore the difference between multi-artery-graft off-pump coronary artery bypass grafting (OPCABG) and single-artery-graft OPCABG on left main coronary artery or multivessel disease with propensity score matching.  Methods · A total of 1 578 patients with left main coronary artery or multivessel disease underwent isolated OPCABG were selected in Ruijin Hospital from January 2012 to September 2016. The propensity score methodology was used to obtain risk-adjusted outcome. Kaplan-Meier analysis was applied for estimation of freedom from major adverse cardiac and cerebrovascular events (MACCE) and readmission for heart disease. Independent predictor of MACCE were assessed by Cox regression analysis.  Results · The average follow-up time was 28 months (7-55 months). There was no statistical difference in short-term clinical endpoints in hospital. In the follow-up results, multi-artery-graft OPCABG patients had statistical improvement in readmission for heart disease (2.7% vs 12.7%, P=0.023), CCS class (1.2±0.4 vs 1.4±0.6, P=0.020) and patency rate of grafts in 1 year after operation (95.8% vs 85.9%, P=0.025), compared with single-artery-graft OPCABG. There was no statistical difference in other endpoints. There was statistical improvement for multi-artery-graft OPCABG patients in freedom from readmission for heart disease (P=0.028). Female was an independent predictor of MACCE (95% CI 0.117-0.906, P=0.032).  Conclusion · Multiartery-graft OPCABG appears to be safe and with good patency of grafts and clinical outcomes in treating left main coronary artery or multivessel disease. The follow up of female patients should be paid more attention.

Key words: multi-artery-graft, off-pump coronary artery bypass grafting, propensity score matching