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急性ST段抬高型心肌梗死患者的冠状动脉旁路移植术

Authors
Oz M Shapira, MD
John A Bittl, MD
Section Editors
Gabriel S Aldea, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC
Translators
葛敏, 副主任医师

引言

对于急性ST段抬高型心肌梗死(ST-elevation myocardial infarction, STEMI)的患者，迅速恢复心肌血流量对于优化心肌挽救及降低死亡率十分关键。这在症状发生后的最初几个小时尤其重要，此时可由再灌注挽救的心肌细胞的总量最大。在几乎所有急性STEMI患者中，及时的冠状动脉再灌注都比无再灌注可改善患者的临床结局。 (参见“急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术：结局的决定因素”，关于‘从到达医院至球囊扩张的时间’一节和“急性ST段抬高型心肌梗死的纤维蛋白溶解疗法：治疗的启动”，关于‘时机’一节)

相较于冠状动脉旁路移植术(coronary artery bypass graft, CABG)，直接经皮冠状动脉介入术(percutaneous coronary intervention, PCI)和纤维蛋白溶解均可在显著更短的时间内恢复急性阻塞的冠状动脉血流，在多数病例中相较于CABG，优选这两种操作。 (参见“急性ST段抬高型心肌梗死：再灌注策略的选择”)

本专题将讨论急性STEMI患者行尽快或紧急CABG的适应证、最佳时机、技术注意事项及结局。CABG在非ST段抬高型心肌梗死或不稳定性心绞痛患者中的作用将单独讨论。 (参见“不稳定型心绞痛或非ST段抬高型急性心肌梗死的冠状动脉造影及血运重建”)

适应证

所有关于PCI或纤维蛋白溶解的研究均显示，从症状发生到再灌注的时间越短，结局就越好。 (参见“急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术：结局的决定因素”，关于‘从到达医院至球囊扩张的时间’一节和“急性ST段抬高型心肌梗死的纤维蛋白溶解疗法：治疗的启动”，关于‘时机’一节)

在多数情况下，PCI或纤维蛋白溶解通常能比CABG更快地恢复缺血心肌的血流，这主要可归因于行CABG时将患者送入手术室的延迟及完成旁路手术操作所需要的时间。因此CABG很少作为STEMI的再灌注治疗的首选策略；据估计，应用CABG的病例仅占5%或更少[1,2]，但对于以下几种STEMI患者，可考虑行CABG。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-20.
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References
Top
  1. Gu YL, van der Horst IC, Douglas YL, et al. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction. Neth Heart J 2010; 18:348.
  2. Stone GW, Brodie BR, Griffin JJ, et al. Role of cardiac surgery in the hospital phase management of patients treated with primary angioplasty for acute myocardial infarction. Am J Cardiol 2000; 85:1292.
  3. Zapolanski A, Rosenblum J, Myler RK, et al. Emergency coronary artery bypass surgery following failed balloon angioplasty: role of the internal mammary artery graft. J Card Surg 1991; 6:439.
  4. Craver JM, Weintraub WS, Jones EL, et al. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience. Ann Surg 1992; 215:425.
  5. Buffet P, Danchin N, Villemot JP, et al. Early and long-term outcome after emergency coronary artery bypass surgery after failed coronary angioplasty. Circulation 1991; 84:III254.
  6. Talley JD, Weintraub WS, Roubin GS, et al. Failed elective percutaneous transluminal coronary angioplasty requiring coronary artery bypass surgery. In-hospital and late clinical outcome at 5 years. Circulation 1990; 82:1203.
  7. Chiu FC, Chang SN, Lin JW, et al. Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: a propensity score analysis. J Thorac Cardiovasc Surg 2009; 138:1326.
  8. Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 2000; 101:27.
  9. Toma M, Buller CE, Westerhout CM, et al. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J 2010; 31:1701.
  10. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574.
  11. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:2574.
  12. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:2610.
  13. Gersh BJ, Chesebro JH, Braunwald E, et al. Coronary artery bypass graft surgery after thrombolytic therapy in the Thrombolysis in Myocardial Infarction Trial, Phase II (TIMI II). J Am Coll Cardiol 1995; 25:395.
  14. Ngaage DL, Cale AR, Cowen ME, et al. Early and late survival after surgical revascularization for ischemic ventricular fibrillation/tachycardia. Ann Thorac Surg 2008; 85:1278.
  15. Every NR, Fahrenbruch CE, Hallstrom AP, et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. J Am Coll Cardiol 1992; 19:1435.
  16. Lee DC, Oz MC, Weinberg AD, et al. Optimal timing of revascularization: transmural versus nontransmural acute myocardial infarction. Ann Thorac Surg 2001; 71:1197.
  17. Kennedy JW, Ivey TD, Misbach G, et al. Coronary artery bypass graft surgery early after acute myocardial infarction. Circulation 1989; 79:I73.
  18. Creswell LL, Moulton MJ, Cox JL, Rosenbloom M. Revascularization after acute myocardial infarction. Ann Thorac Surg 1995; 60:19.
  19. Nunley DL, Grunkemeier GL, Teply JF, et al. Coronary bypass operation following acute complicated myocardial infarction. J Thorac Cardiovasc Surg 1983; 85:485.
  20. Kereiakes DJ, Topol EJ, George BS, et al. Favorable early and long-term prognosis following coronary bypass surgery therapy for myocardial infarction: results of a multicenter trial. TAMI Study Group. Am Heart J 1989; 118:199.
  21. Ryan TJ. Revascularization for acute myocardial infarction. Strategies in need of revision. Circulation 1990; 82:II110.
  22. Naunheim KS, Kesler KA, Kanter KR, et al. Coronary artery bypass for recent infarction. Predictors of mortality. Circulation 1988; 78:I122.
  23. Applebaum R, House R, Rademaker A, et al. Coronary artery bypass grafting within thirty days of acute myocardial infarction. Early and late results in 406 patients. J Thorac Cardiovasc Surg 1991; 102:745.
  24. Hochberg MS, Parsonnet V, Gielchinsky I, et al. Timing of coronary revascularization after acute myocardial infarction. Early and late results in patients revascularized within seven weeks. J Thorac Cardiovasc Surg 1984; 88:914.
  25. Sintek CF, Pfeffer TA, Khonsari S. Surgical revascularization after acute myocardial infarction. Does timing make a difference? J Thorac Cardiovasc Surg 1994; 107:1317.
  26. Lee JH, Murrell HK, Strony J, et al. Risk analysis of coronary bypass surgery after acute myocardial infarction. Surgery 1997; 122:675.
  27. Thielmann M, Neuhäuser M, Marr A, et al. Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction. Ann Thorac Surg 2007; 84:17.
  28. Allen BS, Buckberg GD, Fontan FM, et al. Superiority of controlled surgical reperfusion versus percutaneous transluminal coronary angioplasty in acute coronary occlusion. J Thorac Cardiovasc Surg 1993; 105:864.
  29. Rankin JS, Morris JJ. Utilization of autologous arterial grafts for coronary artery bypass. In: Surgery of the Chest, Sabiston DC, Spencer FC (Eds), WB Saunders, Philadelphia 1995. p.1909.
  30. Mohr R, Moshkovitch Y, Shapira I, et al. Coronary artery bypass without cardiopulmonary bypass for patients with acute myocardial infarction. J Thorac Cardiovasc Surg 1999; 118:50.
  31. Fattouch K, Guccione F, Dioguardi P, et al. Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: a randomized trial. J Thorac Cardiovasc Surg 2009; 137:650.
  32. Gott JP, Han DC. Surgical treatment of acute myocardial infarct: clinical considerations. Semin Thorac Cardiovasc Surg 1995; 7:198.
  33. Dresdale AR, Paone G. Surgical treatment of acute myocardial infarction. Henry Ford Hosp Med J 1991; 39:245.
  34. Berg R Jr, Kendall RW, Duvoisin GE, et al. Acute myocardial infarction: a surgical emergency. J Thorac Cardiovasc Surg 1975; 70:432.
  35. DeWood MA, Notske RN, Berg R Jr, et al. Medical and surgical management of early Q wave myocardial infarction. I. Effects of surgical reperfusion on survival, recurrent myocardial infarction, sudden death and functional class at 10 or more years of follow-up. J Am Coll Cardiol 1989; 14:65.
  36. Every NR, Maynard C, Cochran RP, et al. Characteristics, management, and outcome of patients with acute myocardial infarction treated with bypass surgery. Myocardial Infarction Triage and Intervention Investigators. Circulation 1996; 94:II81.
  37. Guyton RA, Arcidi JM Jr, Langford DA, et al. Emergency coronary bypass for cardiogenic shock. Circulation 1987; 76:V22.
  38. Allen BS, Rosenkranz E, Buckberg GD, et al. Studies on prolonged acute regional ischemia. VI. Myocardial infarction with left ventricular power failure: a medical/surgical emergency requiring urgent revascularization with maximal protection of remote muscle. J Thorac Cardiovasc Surg 1989; 98:691.
  39. Bolooki H. Myocardial revascularization after acute infarction. Am J Cardiol 1975; 36:395.
  40. DeWood MA, Spores J, Notske RN, et al. Medical and surgical management of myocardial infarction. Am J Cardiol 1979; 44:1356.
  41. Berg R Jr, Selinger SL, Leonard JJ, et al. Immediate coronary artery bypass for acute evolving myocardial infarction. J Thorac Cardiovasc Surg 1981; 81:493.
  42. Jones EL, Waites TF, Craver JM, et al. Coronary bypass for relief of persistent pain following acute myocardial infarction. Ann Thorac Surg 1981; 32:33.
  43. Berg R Jr, Selinger SL, Leonard JJ, et al. Acute evolving myocardial infarction. A surgical emergency. J Thorac Cardiovasc Surg 1984; 88:902.
  44. Singh AK, Rivera R, Cooper GN Jr, Karlson KE. Early myocardial revascularization for postinfarction angina: results and long-term follow-up. J Am Coll Cardiol 1985; 6:1121.
  45. Phillips SJ, Zeff RH, Skinner JR, et al. Reperfusion protocol and results in 738 patients with evolving myocardial infarction. Ann Thorac Surg 1986; 41:119.
  46. Jones RN, Pifarré R, Sullivan HJ, et al. Early myocardial revascularization for postinfarction angina. Ann Thorac Surg 1987; 44:159.
  47. Amsel BJ, Walter PJ, Van der Mast M, Vander Sande J. Immediate bypass surgery (0.5-3 h) for evolving myocardial infarction. Adv Cardiol 1988; 36:178.
  48. Collins JJ Jr, Cohn LH, Shemin RJ, DiSesa VJ. Surgical treatment of evolving and sustained myocardial infarction. Adv Cardiol 1988; 36:189.
  49. Flameng W, Sergeant P, Vanhaecke J, Suy R. Emergency aortocoronary bypass surgery: late effects on infarct size and ventricular function. Adv Cardiol 1988; 36:195.
  50. Kirklin JK, Shimazaki Y, Digerness SB, Kirklin JW. Emergent surgical revascularization following acute myocardial infarction. Experimental and clinical considerations. Adv Cardiol 1988; 36:202.
  51. Vidne BA. Emergency coronary artery reperfusion for acute evolving myocardial infarction. Adv Cardiol 1988; 36:219.
  52. Gardner TJ, Stuart RS, Greene PS, Baumgartner WA. The risk of coronary bypass surgery for patients with postinfarction angina. Circulation 1989; 79:I79.
  53. Kouchoukos NT, Murphy S, Philpott T, et al. Coronary artery bypass grafting for postinfarction angina pectoris. Circulation 1989; 79:I68.
  54. Curtis JJ, Walls JT, Salam NH, et al. Impact of unstable angina on operative mortality with coronary revascularization at varying time intervals after myocardial infarction. J Thorac Cardiovasc Surg 1991; 102:867.
  55. Tanaka N, Mukai K, Ade W, et al. Emergency myocardial revascularization for myocardial infarction evolving outside the hospital. A feasible option when thrombolysis and coronary angioplasty have failed. J Cardiovasc Surg (Torino) 1993; 34:215.
  56. Nicolau JC, Ardito RV, Garzon SA, et al. Surgical revascularization after fibrinolysis in acute myocardial infarction. Long-term follow-up. J Thorac Cardiovasc Surg 1994; 107:1454.
  57. Kaul TK, Fields BL, Riggins SL, et al. Coronary artery bypass grafting within 30 days of an acute myocardial infarction. Ann Thorac Surg 1995; 59:1169.
  58. Svensson LG, Cruz H, Sun J, et al. Timing of surgery after acute myocardial infarction. J Cardiovasc Surg (Torino) 1996; 37:467.
  59. Alexiou K, Kappert U, Staroske A, et al. Coronary surgery for acute coronary syndrome: which determinants of outcome remain? Clin Res Cardiol 2008; 97:601.
  60. Filizcan U, Kurc E, Cetemen S, et al. Mortality predictors in ST-elevated myocardial infarction patients undergoing coronary artery bypass grafting. Angiology 2011; 62:68.
  61. Authors/Task Force members, Windecker S, Kolh P, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541.
  62. Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2016; 67:1235.