Effect of prior cardiac operations on survival after coronary artery bypass grafting.
Effect of prior cardiac operations on survival after coronary artery bypass grafting.
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先前的心脏手术对冠状动脉旁路移植术后生存的影响。
DOI：
10.1016/j.athoracsur.2011.05.111
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Ross,Cathy
中科院分区：
文献类型：
--
作者：
Likosky,DonaldS;Surgenor,StephenD;Kramer,RobertS;Russo,Louis;Leavitt,BruceJ;Sorensen,MeredithJ;Helm,RobertE;Sardella,GeraldL;Dipierro,FrancisV;Baribeau,YvonR;Malenka,DavidJ;Mackenzie,ToddA;Brown,JeremiahR;Ross,Cathy
研究背景我们研究了最近的区域经验，以确定心脏手术对冠状动脉旁路移植术（CABG）后短期和中期结果的影响。方法我们确定了2000年至2008年在北方新英格兰8个中心接受非急诊CABG的20,703例患者，其中818例（3.8%）接受过心脏手术。使用最小或完全胸骨切开术的既往CABG被视为既往胸骨切开术。从社会保障管理局死亡指数的链接中获得了4年的生存数据。使用考克斯比例风险回归模型估计风险比，使用逆概率加权估计校正的生存曲线。在一项单独的分析中，1,182例患者按患者既往接受过CABG的倾向1：1匹配。既往接受过胸骨切开术的患者有更大的共病负担，急性加重，因出血和低心输出量衰竭返回手术室的可能性更大。对于接受CABG的患者，既往胸骨切开术与4年内死亡风险增加相关，未匹配的风险比为1.34（95%置信区间，1.10至1.64），匹配风险比为1.36（95%置信区间，1.01至1.81）结论：对我们最近的非急诊冠状动脉旁路移植术的区域经验的分析表明，既往心脏手术与近两倍的增加有关。随访4年时的死亡风险。
BACKGROUNDWe examined a recent regional experience to determine the effect of a prior cardiac operation on short-term and midterm outcomes after coronary artery bypass grafting (CABG).METHODSWe identified 20,703 patients who underwent nonemergent CABG at 8 centers in northern New England from 2000 to 2008, of whom 818 (3.8%) had undergone prior cardiac operations. Prior CABG using a minimal or full sternotomy was considered a prior sternotomy. Survival data out to 4 years were obtained from a link with the Social Security Administration Death Index. Hazard ratios were estimated using a Cox proportional hazards regression model, and adjusted survival curves were estimated using inverse probability weighting. In a separate analysis, 1,182 patients were matched 1:1 by a patient's propensity for having undergone prior CABG.RESULTSPatients with prior sternotomies had a greater burden of comorbid diseases and increased acuity and had a greater likelihood of returning to the operating room for bleeding and low cardiac output failure. Prior sternotomy was associated with an increased risk of death out to 4 years for patients undergoing CABG, with an unmatched hazard ratio of 1.34 (95% confidence interval, 1.10 to 1.64) and a matched hazard ratio of 1.36 (95% confidence interval, 1.01 to 1.81).CONCLUSIONSAnalyses of our recent regional experience with nonemergent CABG showed that a prior cardiac operation was associated with a nearly twofold increased hazard of death at up to 4 years of follow-up.
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