ISOLATED CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS 75 YEARS OF AGE AND OLDER - IS AGE PER SE A CONTRAINDICATION
ISOLATED CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS 75 YEARS OF AGE AND OLDER - IS AGE PER SE A CONTRAINDICATION
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DOI：
10.1055/s-2007-1020182
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发表时间：
1992-12-01
影响因子：
1.5
通讯作者：
VANAKEN, D
中科院分区：
文献类型：
--
作者：
MOHAN, R;WALTER, PJ;VANAKEN, D
137例平均年龄为77.3岁的患者（a组）接受了孤立性冠状动脉旁路移植术（CABG），与137例平均年龄为55.6岁的患者（B组）在与a组相同或相邻的一天接受了孤立性冠状动脉旁路移植术（CABG）进行了比较。A组患者多为女性，不稳定型心绞痛、急诊手术、广泛性冠状动脉疾病、外周血管疾病和多器官衰弱的发生率明显较高。然而，他们的左心室功能和血运重建的程度与B组患者相似。他们的手术死亡率（7.2% vs 1.45%, p < 0.001）、心脏和非心脏并发症以及住院时间（14.2 vs 8.8天，p < 0.001）也明显高于B组患者。在平均29.8个月的随访中，a组与B组患者在长期生存率（95%对94%）、心绞痛缓解（82%对81%）、心脏再入院（10%对12%）、新发心肌梗死或新冠状动脉搭桥发生率方面无显著差异。4年精算生存率A组为76.9%，B组为90.1%。由于广泛的冠状动脉疾病导致的严重心绞痛通常使得在这一不断增长的高龄患者群体中不可避免地进行紧急手术，但手术死亡率不高，幸存者确实享有数年的生命，与相似但年轻的患者一样，没有心绞痛等。
137 patients with a mean age of 77.3 years (Group A) who underwent isolated coronary artery bypass grafting (CABG) were compared to 137 patients with a mean age of 55.6 years (Group B) who also underwent isolated CABG on the same or the adjacent day as the Group A patients. Group A patients were more commonly women, and had a significantly higher incidence of unstable angina, emergency operations, extensive coronary disease, peripheral vascular disease, and multiorgan debility. However, their left-ventricular function and the extent of revascularisation was similar to Group B patients. They also had significantly more operative mortality (7.2 % vs 1.45 %, p < 0.001), cardiac and non-cardiac complications, and longer hospital stay (14.2 vs 8.8 days, p < 0.001) than group B patients. At a mean follow-up of 29.8 months, no significant differences were noted in Group A versus Group B patients in terms of long-term survival (95 % vs 94 %), freedom from angina (82 % vs 81 %), cardiac readmission (10 % vs 12 %), or in the incidence of new myocardial infarction or new CABG. Actuarial survival at 4 years was 76.9 % in Group A patients and 90.1 % in Group B patients. Severe angina due to extensive coronary disease commonly makes urgent surgery unavoidable in this growing population of very old patients, but the operative mortality is modest and survivors do enjoy several years of life, remaining as free of angina, etc., as similar but younger patients.