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在ST升高心肌梗塞患者中冠状动脉绕道移植的结果和Impella的影响:回顾性单中心研究

Kazuyoshi Takagi¹, Takahiro Shojima¹, Takanori Kono¹

¹Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN.

|August 22, 2025

概括

在ST段升高心肌梗塞 (STEMI) 中,冠状动脉旁路移植 (CABG) 仍然有效. Impella 装置可能有助于转向较少出现的 CABG,改善患者的选择和结果.

科学领域:

心血管外科
干预心脏病学
机械循环支持

背景情况:

ST段升高心肌梗塞 (STEMI) 往往需要紧急重血管化,而皮肤冠状动脉干预 (PCI) 是主要的方法.
冠状动脉旁路移植 (CABG) 对STEMI病例至关重要,因为PCI是不可行的或失败的,尽管紧急CABG具有很高的风险,特别是在不稳定的患者中.
通过皮肤提供机械循环支持 (MCS),稳定血液动力学和改善末端器官 perfusion,可能使手术前稳定.

研究的目的:

在STEMI患者中评估CABG的结果.
评估Impella装置对STEMI病例中CABG的指示,时间和患者选择的影响.

主要方法:

在2012年至2023年期间接受CABG的59名连续STEMI患者的回顾性分析.
患者被分为紧急,紧急或选择性CABG组.
在 (2012-2018) 和 (2019-2023) 引入Impella装置之前的临床和程序数据的比较.

主要成果:

整体医院死亡率低 (1.7%),急诊病例死亡率没有显著增加.
术后并发症在紧急CABG (43. 3%) 中是最高的,并且在Impella引入后减少 (40%紧急而不是50%紧急).
在Impella后,STEMI的CABG率下降了 (11. 2%至4. 3%),急诊程序减少,MCS的使用增加.

结论:

对于高风险的STEMI患者来说,CABG是一种可行的选择.
伊佩拉装置似乎与CABG指示从不合适的PCI转变为失败的PCI有关.
在引入Impella后,STEMI患者的CABG手术时间出现的趋势较少.

关键词:

冠状动脉旁路移植一个机构结果通过皮肤进行冠状动脉干预心肌梗塞的升高

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