Influence of age on results of coronary artery surgery.
Influence of age on results of coronary artery surgery.
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发表时间：
1991-11
期刊：
影响因子：
37.8
通讯作者：
William S. Weintraub;Craver Jm;C. Cohen;Jones El;Robert A. Guyton
中科院分区：
文献类型：
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作者：
William S. Weintraub;Craver Jm;C. Cohen;Jones El;Robert A. Guyton
冠状动脉外科手术越来越多地用于老年人和病情更严重的患者。为了评估年龄在预测冠状动脉手术后并发症和死亡率方面的重要性，对13，625例接受冠状动脉手术的患者的结果进行了评估。40岁以下患者321人，40-49岁1,758人，50-59岁4,167人，60-69岁5,049人，70-79岁2,184人，80岁以上146人。随着患者年龄的增长，女性比例增加，严重心绞痛和充血性心力衰竭的患病率增加，冠状动脉狭窄分布的严重程度增加。40岁以后，神经系统事件、伤口感染和死亡并发症的发生率每十年上升一次。40-49岁患者的死亡发生率为0.6%，50-59岁患者为1.5%，60-69岁患者为1.9%，70-79岁患者为5.0%，80-89岁患者为8.3%。高龄是神经系统事件、伤口感染和死亡的最显著独立相关因素。神经系统事件的其他多变量相关因素是糖尿病、高血压，令人惊讶的是，还有心绞痛分级。再次令人惊讶的是，伤口感染的唯一其他多变量相关性是心绞痛分级。其他与死亡相关的多变量因素包括急诊手术、女性、射血分数、冠状动脉疾病严重程度、糖尿病和充血性心力衰竭史。值得注意的是，围手术期Q波心肌梗死与年龄无关。围手术期心肌梗死最具预测性和显著性的相关因素是急诊手术;高血压、既往无心肌梗死和射血分数正常的相关性较弱。与预测死亡的能力相比，预测任何并发症的能力相对较弱。80岁以上冠心病手术相对较少，这表明老年人对手术的选择已经很强。此外，死亡的风险，以及在某种程度上其他并发症，可以提前预测基于广泛的患者经验。
Coronary surgery is being used increasingly in older and more seriously ill patients. To evaluate the importance of age in predicting complications and mortality after coronary surgery, the results in 13,625 patients undergoing coronary surgery were evaluated. There were 321 patients under the age of 40, 1,758 were 40-49, 4,167 were 50-59, 5,049 were 60-69, 2,184 were 70-79, and 146 were over 80. As patients aged the proportion of women increased, the prevalence of severe angina and congestive heart failure increased, and the severity of the distributions of the coronary stenoses increased. The incidence of the complications of neurological events, wound infections, and death rose in every decade after the age of 40 years. The incidence of death was 0.6% for patients aged 40-49, 1.5% for those aged 50-59, 1.9% for those aged 60-69, 5.0% for those aged 70-79, and 8.3% for those aged 80-89. Advanced age was the most significant independent correlate of neurological events, wound infections, and death. The other multivariate correlates of neurological events were diabetes, hypertension, and, surprisingly, angina class. Again surprisingly, the only other multivariate correlate of wound infections was angina class. The other multivariate correlates of death were emergent surgery, female gender, ejection fraction, severity of coronary disease, diabetes, and a history of congestive heart failure. Of interest, periprocedural Q wave myocardial infarction was independent of age. The most predictive and significant correlate of periprocedural myocardial infarction was emergent surgery; hypertension, absence of a previous myocardial infarction, and a normal ejection fraction were weaker correlates. The ability to predict any complication was relatively weak compared with the ability to predict death. The relative infrequency of coronary surgery over the age of 80 years suggests that there is already strong selection against surgery in octogenarians. In addition, the risk of death, and to some extent other complications, may be predicted in advance based on extensive patient experience.