Mortality on the waiting list for coronary artery bypass grafting:: Incidence and risk factors
Mortality on the waiting list for coronary artery bypass grafting:: Incidence and risk factors
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DOI：
10.1016/j.athoracsur.2003.05.007
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发表时间：
2004-03-01
影响因子：
4.6
通讯作者：
Jeppsson, A
中科院分区：
文献类型：
--
作者：
Rexius, H;Grandrup-Wognsen, G;Jeppsson, A
背景。冠状动脉旁路移植术的容量不足导致手术前的等待时间，患者的优先次序以及最终在等待名单上死亡。我们的目的是计算等候名单上的死亡率，并确定等候名单上死亡的危险因素。该研究包括5,864例连续接受择期冠状动脉旁路移植术的患者（78%为男性，平均年龄66±9岁）。患者在接受时被分为三个优先组：紧急（39%），紧急（36%）或常规（25%）。计算并比较各组之间的等候名单死亡率，并通过泊松回归确定危险因素。全体患者的平均等待时间为55天。77名患者（1.3%）死亡，相当于每100名患者年5.8例死亡。急诊组每100例患者年死亡率最高，为15.1例，而急诊组为5.3例，常规组为3.2例（p < 0.001）。独立危险因素为男性（P = 0.032）、克利夫兰诊所危险评分（P = 0.005）、左室射血分数受损（P = 0.007）、不稳定型心绞痛（P = 0.001）、合并主动脉瓣疾病（P = 0.002）、优先组（P < 0.001）、接受治疗后时间（P = 0.019）。接受后死亡风险随时间增加，每月增加11%。冠状动脉旁路移植术的长时间等待名单与相当高的死亡率有关。随着等待时间的延长，死亡风险显著增加。性别、不稳定型心绞痛、围手术期风险、左心室功能受损和合并主动脉瓣疾病是独立的危险因素，在分诊时应予以考虑。(C) 2004年由胸外科学会出版。
Background. Insufficient capacity for coronary artery bypass grafting results in waiting times before operation, prioritization of patients and, ultimately, death on the waiting list. We aimed to calculate waiting list mortality and to identify risk factors for death on the waiting list.Methods. The study included 5,864 consecutive patients accepted for elective coronary artery bypass grafting (78% male; mean age, 66 +/- 9 years). The patients were categorized at acceptance into three priority groups: imperative (39%), urgent (36%), or routine (25%). Waiting list mortality was calculated and compared between groups, and risk factors were identified by Poisson regression.Results. Median waiting time for the whole population was 55 days. Seventy-seven patients (1.3%) died, corresponding to a mortality rate of 5.8 deaths per 100 patient-years. The mortality rate per 100 patient-years was highest for those in the imperative group, 15.1 deaths, compared with 5.3 deaths in the urgent group and 3.2 in the routine group (p < 0.001). Independent risk factors were male sex (P = 0.032), Cleveland Clinic risk score (p = 0.005), impaired left ventricular ejection fraction (p = 0.007), unstable angina pectoris (p = 0.001), concomitant aortic valve disease (p = 0.002), priority group (p < 0.001), and time after acceptance (p = 0.019). The mortality risk increased with time after acceptance by 11% a month.Conclusions. Long waiting lists for coronary artery bypass grafting are associated with considerable mortality. The risk of death increases significantly with waiting time. Sex, unstable angina, perioperative risk, impaired left ventricular function, and concomitant aortic valve disease are independent risk factors and should be considered at triage. (C) 2004 by The Society of Thoracic Surgeons.