PDF(Pubmed)
Abstract：
BACKGROUND: The aim of this study was to determine whether pre-operative intra-aortic balloon pump (IABP) insertion improves surgical outcomes in high-risk coronary artery bypass grafting (CABG) patients.
METHODS: Patients with a EuroSCORE II greater than 1.2% who underwent CABG from 2009 to 2016 were included in the study, while those who utilized intra-operative or post-operative IABP were excluded. The analysis included a total of 2907 patients, with 377 patients undergoing preoperative IABP insertion (EuroSCORE II > 5.018%) and 1198 patients in the non-IABP group before matching; after propensity score matching (PSM), both groups consisted of a matched cohort of 250 patients.
RESULTS: 30-day mortality events occurred in 9 (3.6%) non-IABP group and in 12 (4.8%) IABP patients (OR: 1.33 95%CI: 0.52-3.58). Kaplan-Meier survival curve analysis showed no significant differences between the two groups in mortality up to one year after the operation (p = 0.72). On multivariate analysis, IABP usage among the PSM patients was associated with lower 30-day mortality (OR: 0.28, 95%CI: 0.07-0.92, P-value = 0.043), 90-day mortality (OR: 0.26, 95%CI: 0.08-0.78, P-value = 0.022) and reduced risk of developing severe respiratory disorders (OR: 0.10, 95%CI:0.01-0.50, P-value = 0.011).
CONCLUSIONS: Pre-operative IABP use in high-risk patients reduces 30- and 90-day mortality rates, along with a notable decrease in rates of severe respiratory disorders.
METHODS: Patients with a EuroSCORE II greater than 1.2% who underwent CABG from 2009 to 2016 were included in the study, while those who utilized intra-operative or post-operative IABP were excluded. The analysis included a total of 2907 patients, with 377 patients undergoing preoperative IABP insertion (EuroSCORE II > 5.018%) and 1198 patients in the non-IABP group before matching; after propensity score matching (PSM), both groups consisted of a matched cohort of 250 patients.
RESULTS: 30-day mortality events occurred in 9 (3.6%) non-IABP group and in 12 (4.8%) IABP patients (OR: 1.33 95%CI: 0.52-3.58). Kaplan-Meier survival curve analysis showed no significant differences between the two groups in mortality up to one year after the operation (p = 0.72). On multivariate analysis, IABP usage among the PSM patients was associated with lower 30-day mortality (OR: 0.28, 95%CI: 0.07-0.92, P-value = 0.043), 90-day mortality (OR: 0.26, 95%CI: 0.08-0.78, P-value = 0.022) and reduced risk of developing severe respiratory disorders (OR: 0.10, 95%CI:0.01-0.50, P-value = 0.011).
CONCLUSIONS: Pre-operative IABP use in high-risk patients reduces 30- and 90-day mortality rates, along with a notable decrease in rates of severe respiratory disorders.
摘要：
背景：本研究的目的是确定术前主动脉内球囊反搏（IABP）插入是否可以改善高危冠状动脉旁路移植术（CABG）患者的手术效果。
方法：2009年至2016年接受CABG的EuroSCOREII大于1.2％的患者被纳入研究，而那些使用术中或术后IABP的患者被排除在外。该分析共包括2907名患者，377例患者进行术前插入IABP（EuroSCOREII>5.018％），非IABP组1198例患者在匹配前；在倾向评分匹配（PSM）后，两组均由250例患者的匹配队列组成.
结果：30天死亡事件发生在9例(3.6%)非IABP组和12例(4.8%)IABP患者中(OR:1.3395CI:0.52-3.58)。Kaplan-Meier生存曲线分析显示两组术后1年死亡率差异无统计学意义(p=0.72)。在多变量分析中，PSM患者使用IABP与30天死亡率较低相关(OR:0.28,95CI:0.07-0.92,P值=0.043),90天死亡率（OR：0.26，95CI：0.08-0.78，P值=0.022）和发生严重呼吸系统疾病的风险降低（OR：0.10，95CI：0.01-0.50，P值=0.011）。
结论：在高危患者中使用术前IABP可降低30天和90天的死亡率，以及严重呼吸系统疾病的发病率显着下降。
方法：2009年至2016年接受CABG的EuroSCOREII大于1.2％的患者被纳入研究，而那些使用术中或术后IABP的患者被排除在外。该分析共包括2907名患者，377例患者进行术前插入IABP（EuroSCOREII>5.018％），非IABP组1198例患者在匹配前；在倾向评分匹配（PSM）后，两组均由250例患者的匹配队列组成.
结果：30天死亡事件发生在9例(3.6%)非IABP组和12例(4.8%)IABP患者中(OR:1.3395CI:0.52-3.58)。Kaplan-Meier生存曲线分析显示两组术后1年死亡率差异无统计学意义(p=0.72)。在多变量分析中，PSM患者使用IABP与30天死亡率较低相关(OR:0.28,95CI:0.07-0.92,P值=0.043),90天死亡率（OR：0.26，95CI：0.08-0.78，P值=0.022）和发生严重呼吸系统疾病的风险降低（OR：0.10，95CI：0.01-0.50，P值=0.011）。
结论：在高危患者中使用术前IABP可降低30天和90天的死亡率，以及严重呼吸系统疾病的发病率显着下降。
