低射血分数患者接受非体外循环冠状动脉旁路移植术的长期预后分析

目的总结低左心室射血分数(≤40%)冠心病患者行非体外循环冠状动脉旁路移植术(OPCAB)的手术疗效及预后相关因素。方法回顾性分析2001～2004年在北京大学人民医院行OPCAB的低射血分数患者顺利出院63例的随访临床资料,男48例,女15例;平均年龄(65.1±9.2)岁,左心室射血分数为33.8%±5.0%,对其长期随访,使用Kaplan-Meier法绘制生存曲线,采用单因素对数秩检验(log-rank test)和Cox回归模型分析影响患者长期预后的危险因素。结果随访时间3～107(71.3±24.4)个月,失访6例(9.5%)。随访期内死亡19例(30.2%),其中与心脏相关死亡10例(15.9%)。术后1年、3年、5年、8年的生存率分别为96.7%(61)、94.9%(60)、85.9%(55)、77.2%(53)。单因素分析表明,左心室射血分数≤30%、急性心肌梗死<30 d(急性心肌梗死发生30 d内即接受手术)是影响患者远期生存率的潜在危险因素(P<0.05)。Cox回归分析表明,左心室射血分数≤30%(RR=4.662,P<0.05)及心肌梗死<30 d(RR=5.544,P<0.05)是择期OPCAB患者术后发生心脏相关死亡的独立危险因素。结论低左心室射血分数冠心病患者行OPCAB治疗效果良好。左心室射血分数≤30%及急性心肌梗死<30 d是择期OPCAB患者术后发生心脏相关死亡的独立危险因素。

Long-term Outcomes of Off-pump Coronary Artery Bypass Grafting in Patients with Low Left Ventricular Ejection Fraction

Objective To investigate surgical outcomes and prognostic factors for patients with coronary heart disease and low left ventricular ejection fraction(LVEF≤40%) undergoing off-pump coronary artery bypass grafting(OPCAB).Methods We retrospectively analyzed clinical records of 63 discharged patients with coronary heart disease and low LVEF who underwent OPCAB in Peking University People’s Hospital from 2001 to 2004 year.There were 48 males and 15 females with mean age of 65.1±9.2 years and mean LVEF of 33.8%±5.0%.Regular follow-up evaluation was completed.We investigated risk factors for long-term survival of the patients by Kapalan-Meier survival curve,log-rank test and Cox regression model.Results Follow-up time was 3-107(71.3±24.4) months,and six patients were lost during the follow-up.Nineteen patients(30.2%) died during follow-up including 10 patients(15.9%) who had cardiac-related death.The survival rate at 1,3,5 and 8 year was 96.7%(61),94.9%(60),85.9%(55),77.2%(53) respectively.Univariate analysis shows LVEF≤30% and acute myocardial infarction within 30 days are risk factors for long-term survival(P<0.05).Cox regression analysis showed that LVEF≤30%(RR=4.662,P<0.05)and acute myocardial infarction within 30 days(RR=5.544,P<0.05)were two independent risk factors for cardiac-related death after discharge.Conclusion Patients with coronary heart disease and low LVEF can have satisfactory surgical outcomes after OPCAB.LVEF≤30% and acute myocardial infarction within 30 days are the two independent risk factors for cardiac-related death after discharge.