.: ORİJİNAL ARAŞTIRMA
Effect of Previous Stent Implantation in Elective Coronary Artery Bypass Grafting Operation; Multivariate Analysis of 1,259 Patients: Retrospective Clinical Trial
Geçirilmiş Stent İmplantasyonunun Elektif Koroner Arter Baypas Greft Operasyonundaki Etkisi; 1.259 Hastanın Multivaryant Analizi: Retrospektif Klinik Çalışma
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(2):31-7
doi: 10.5336/cardiosci.2022-95172
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: This study aims to investigate the effect of previous stent implantation on early mortality in patients undergoing elective coronary artery bypass grafting (CABG). Material and Methods: A total of 1,259 patients who underwent elective isolated CABG between January 2015 and December 2016 were included. There were 970 patients in the CABG without stent group and 289 patients in the CABG with stent group. Preoperative, intraoperative, and postoperative data of both groups were compared. Predictors of early mortality in CABG were examined using the logistic regression analysis. Results: Early mortality rates after surgery between the groups were similar (CABG without stent group vs. CABG with stent group; 2.9% vs. 3.1%, p=0.998). The length of intensive care unit stay, the use of intraaortic balloon pump, tracheotomy, new dialysis, revision and the use of extracorporeal membrane oxygenator were also comparable between the groups (p>0.05). The mean number of grafts was significantly lower in the CABG with stent group than the CABG without stent group (2.62±0.91 vs. 2.87±0.9; p<0.001 respectively). Multivariate analysis revealed that an ejection fraction of ≤40% [odds ratio (OR): 3.8; 95% confidence interval (CI): 1.9-7.7; p<0.001], preoperative renal failure (OR: 3.7; 95% CI: 1.5-8.8; p=0.003), and advanced age (OR: 1.07; 95% CI: 1.03-1.1; p<0.001) were independent predictors of early mortality. Previous stent implantation has not been found out as a risk factor for early mortality (OR: 1.08; 95% CI: 0.5-2.3; p=0.998). Conclusion: Previous stent implantation was not found to be a factor affecting early mortality in patients undergoing elective CABG operations.
Keywords: Coronary artery bypass; cardiopulmonary bypass; extracorporeal membrane oxygenation; percutaneous transluminal coronary angioplasty; stents
Objective: This study aims to investigate the effect of previous stent implantation on early mortality in patients undergoing elective coronary artery bypass grafting (CABG). Material and Methods: A total of 1,259 patients who underwent elective isolated CABG between January 2015 and December 2016 were included. There were 970 patients in the CABG without stent group and 289 patients in the CABG with stent group. Preoperative, intraoperative, and postoperative data of both groups were compared. Predictors of early mortality in CABG were examined using the logistic regression analysis. Results: Early mortality rates after surgery between the groups were similar (CABG without stent group vs. CABG with stent group; 2.9% vs. 3.1%, p=0.998). The length of intensive care unit stay, the use of intraaortic balloon pump, tracheotomy, new dialysis, revision and the use of extracorporeal membrane oxygenator were also comparable between the groups (p>0.05). The mean number of grafts was significantly lower in the CABG with stent group than the CABG without stent group (2.62±0.91 vs. 2.87±0.9; p<0.001 respectively). Multivariate analysis revealed that an ejection fraction of ≤40% [odds ratio (OR): 3.8; 95% confidence interval (CI): 1.9-7.7; p<0.001], preoperative renal failure (OR: 3.7; 95% CI: 1.5-8.8; p=0.003), and advanced age (OR: 1.07; 95% CI: 1.03-1.1; p<0.001) were independent predictors of early mortality. Previous stent implantation has not been found out as a risk factor for early mortality (OR: 1.08; 95% CI: 0.5-2.3; p=0.998). Conclusion: Previous stent implantation was not found to be a factor affecting early mortality in patients undergoing elective CABG operations.
Keywords: Coronary artery bypass; cardiopulmonary bypass; extracorporeal membrane oxygenation; percutaneous transluminal coronary angioplasty; stents
ÖZET
Amaç: Bu çalışmada, koroner arter baypas greftleme (KABG) yapılan hastalarda geçirilmiş stent implantasyonunun erken dönem mortaliteye olan etkisi araştırıldı. Gereç ve Yöntemler: Ocak 2015- Aralık 2016 yılları arasında elektif izole KABG yapılan toplam 1.259 hasta çalışmaya dâhil edildi. KABG stentsiz grupta 970 hasta yer alırken, KABG stentli grupta 289 hasta vardı. Her iki grup ameliyat öncesi, ameliyat sırası ve ameliyat sonrası özellikler açısından karşılaştırıldı. Lojistik regresyon analizi ile KABG'de erken dönem mortaliteyi etkileyen faktörler araştırıldı. Bulgular: Ameliyat sonrası erken mortalite oranları her iki grupta benzerdi (KABG stentsiz gruba oranla KABG stentli grup; %2,9'a karşı %3,1, p=0,998). Yoğun bakım ünitesinde kalış süresi, intraaortik balon pompası kullanım oranı, trakeostomi, yeni diyaliz, reviyon ve ekstrakorporeal sirkülasyon kullanım oranları her iki grupta karşılaştırılabilir düzeydeydi (p>0,05). Ortalama greft sayısı, KABG stentli grupta, KABG stentsiz gruba göre anlamlı düzeyde daha düşüktü (2,62±0,91'e karşı 2,87±0,9; p<0,001). Çok değişkenli analizde ≤%40 ejeksiyon fraksiyon [göreceli olasılıklar oranı (odds ratio ''OR''): 3,8; %95 güven aralığı (confidence interval ''CI''): 1,9-7,7; p<0,001], ameliyat öncesi böbrek yetersizliği (OR: 3,7; %95 CI: 1,5-8,8; p=0,003) ve ileri yaş (OR: 1,07; %95 CI: 1,03-1,1; p<0,001) erken dönem mortaliteyi etkileyen bağımsız öngördürücüler olarak bulundu. Geçirilmiş stent implantasyonu, erken mortaliteyi etkileyen bir risk faktörü olarak saptanmadı (OR: 1,08; %95 CI: 0,5-2,3; p=0,998). Sonuç: Elektif koroner arter baypas operasyonu yapılan hastalarda, geçirilmiş stent implantasyonu erken mortaliteyi etkileyen bir faktör olarak bulunmamıştır.
Anahtar Kelimeler: Koroner arter baypas; kardiyopulmoner baypas; yapay dolaşım membran oksijenasyonu; perkütan translüminal koroner anjiyoplasti; stentler
Amaç: Bu çalışmada, koroner arter baypas greftleme (KABG) yapılan hastalarda geçirilmiş stent implantasyonunun erken dönem mortaliteye olan etkisi araştırıldı. Gereç ve Yöntemler: Ocak 2015- Aralık 2016 yılları arasında elektif izole KABG yapılan toplam 1.259 hasta çalışmaya dâhil edildi. KABG stentsiz grupta 970 hasta yer alırken, KABG stentli grupta 289 hasta vardı. Her iki grup ameliyat öncesi, ameliyat sırası ve ameliyat sonrası özellikler açısından karşılaştırıldı. Lojistik regresyon analizi ile KABG'de erken dönem mortaliteyi etkileyen faktörler araştırıldı. Bulgular: Ameliyat sonrası erken mortalite oranları her iki grupta benzerdi (KABG stentsiz gruba oranla KABG stentli grup; %2,9'a karşı %3,1, p=0,998). Yoğun bakım ünitesinde kalış süresi, intraaortik balon pompası kullanım oranı, trakeostomi, yeni diyaliz, reviyon ve ekstrakorporeal sirkülasyon kullanım oranları her iki grupta karşılaştırılabilir düzeydeydi (p>0,05). Ortalama greft sayısı, KABG stentli grupta, KABG stentsiz gruba göre anlamlı düzeyde daha düşüktü (2,62±0,91'e karşı 2,87±0,9; p<0,001). Çok değişkenli analizde ≤%40 ejeksiyon fraksiyon [göreceli olasılıklar oranı (odds ratio ''OR''): 3,8; %95 güven aralığı (confidence interval ''CI''): 1,9-7,7; p<0,001], ameliyat öncesi böbrek yetersizliği (OR: 3,7; %95 CI: 1,5-8,8; p=0,003) ve ileri yaş (OR: 1,07; %95 CI: 1,03-1,1; p<0,001) erken dönem mortaliteyi etkileyen bağımsız öngördürücüler olarak bulundu. Geçirilmiş stent implantasyonu, erken mortaliteyi etkileyen bir risk faktörü olarak saptanmadı (OR: 1,08; %95 CI: 0,5-2,3; p=0,998). Sonuç: Elektif koroner arter baypas operasyonu yapılan hastalarda, geçirilmiş stent implantasyonu erken mortaliteyi etkileyen bir faktör olarak bulunmamıştır.
Anahtar Kelimeler: Koroner arter baypas; kardiyopulmoner baypas; yapay dolaşım membran oksijenasyonu; perkütan translüminal koroner anjiyoplasti; stentler
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