Impact of complete revascularization on long-term survival after coronary artery bypass grafting in octogenarians
Impact of complete revascularization on long-term survival after coronary artery bypass grafting in octogenarians
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DOI：
10.1016/j.athoracsur.2005.02.017
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发表时间：
2005-07-01
影响因子：
4.6
通讯作者：
Damiano, RJ
中科院分区：
文献类型：
--
作者：
Kozower, BD;Moon, MR;Damiano, RJ
背景资料。完全血运重建。对于接受冠状动脉旁路移植术的年轻患者来说很重要，但这一原则在老年患者中仍然不是那么绝对。本研究的目的是确定完全血运重建如何影响八旬老人冠状动脉搭桥术后的长期存活率。从1986年到2003年，连续500名年龄在80岁到94岁之间的患者接受了冠状动脉搭桥术。完全血运重建的定义是在包括直径50%的病变的三个主要血管区域中的每个区域放置至少一个移植物。400例(80%)患者血运重建完全，100例(20%)患者血管重建不完全。平均(+/-标准差)随访51+/-41个月，完成99%(2,102个病人年)。手术死亡率为8%+/-2%(95%可信区间)，完全血运重建组(7%+/-3%)显著低于不完全血运重建组(13%+/-7%)(p<；0.05)。在459名手术幸存者中，有261名晚期死亡。多变量回归分析确定了6个独立预测晚期死亡的因素：手术年限较早、男性、周围或脑血管疾病、充血性心力衰竭和不完全血运重建(P<；全部为0.03)。剔除手术死亡，完全血运重建组的平均生存期(Kaplan-Meier)为82个月，不完全血运重建组为65个月(P<；0.008)。5年完全血运重建组的生存率为62%+/-3%，不完全血运重建组为45%+/-6%；8年完全血运重建组为39%+/-3%，不完全血运重建组为25%+/-6%(p<；0.008)。在接受冠状动脉搭桥术的八旬老人中，完全血运重建术与改善长期存活率相关，与不完全血运重建术相比，平均存活率增加近25%。(C)2005年，由胸外科医生学会提供。
Background. Complete revascularization. is important in young patients undergoing coronary artery bypass grafting, but this principle remains less absolute in elderly patients. The purpose of this study was to determine how complete revascularization influenced long-term survival after coronary artery bypass grafting in octogenarians.Methods. From 1986 to 2003, 500 consecutive patients 80 to 94 years of age underwent coronary artery bypass grafting. Complete revascularization was defined as placement of at least one graft to each of the three major vascular regions that included a 50% diameter lesion. Revascularization was complete in 400 (80%) patients and incomplete in 100 (20%) patients. Mean (+/- standard deviation) follow-up was 51 +/- 41 months and was 99% complete (2,102 total patient-years).Results. Operative mortality was 8% +/- 2% ( 95% confidence interval) and was statistically lower with complete (7% +/- 3%) versus incomplete (13% +/- 7%) revascularization (p < 0.05). Of 459 operative survivors, there were 261 late deaths. Multivariate regression analysis identified six independent predictors of late death: earlier operative year, male sex, peripheral or cerebrovascular disease, congestive heart failure, and incomplete revascularization (p < 0.03 for all). Excluding operative deaths, mean survival (Kaplan-Meier) was 82 months with complete revascularization compared with 65 months with incomplete revascularization (p < 0.008). Survival was 62% +/- 3% with complete versus 45% +/- 6% with incomplete revascularization at 5 years and 39% 3% with complete versus 25% +/- 6% with incomplete revascularization at 8 years (p < 0.008).Conclusions. In octogenarians undergoing coronary artery bypass grafting, complete revascularization correlated with improved long-term survival, increasing mean survival by almost 25% compared with incomplete revascularization. (c) 2005 by The Society of Thoracic Surgeons.