Risk of Stroke After Coronary Artery Bypass Grafting Effect of Age and Comorbidities
Risk of Stroke After Coronary Artery Bypass Grafting Effect of Age and Comorbidities
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DOI：
10.1161/strokeaha.111.620880
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发表时间：
2012-01-01
期刊：
影响因子：
8.3
通讯作者：
Torp-Pedersen, Christian
中科院分区：
文献类型：
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作者：
Merie, Charlotte;Kober, Lars;Torp-Pedersen, Christian
背景和目的-已知冠状动脉旁路移植术(CABG)后中风的风险随着年龄的增长而显著增加。近年来，手术患者的年龄增加了，同期治疗也发生了变化。因此，我们重新评估了CABG术后卒中的风险。方法：通过丹麦国家医院登记表，我们确定了1997-2006年间所有25 159例单纯性CABG患者。中风、合并症和药物治疗也得到了进一步的改善。结果：1901例患者(7.6%)术后发生卒中，477例患者(2.0%)术后30d内发生卒中。术后30天内每百人年卒中发生率(95%CI)随年龄增加：=80岁、38.0岁(25.2-57.1)。根据年龄调整后，术后30天内发生中风的风险(参考：年龄=80岁：HR，3.0(P=0.001；95%CI，1.8-4.9)，既往中风史：HR，4.2(P=0.001；95%CI，3.3-5.4)，糖尿病：HR，1.3(P=0.019；95%CI，1.1-1.7)，高血压：HR，1.4(P=0.003；95%CI，1.1-1.7)，外周血管疾病：HR，1.6(P=0.001；肾功能衰竭：HR，1.7(P=0.012；95%CI，1.1~2.5)，他汀类药物：HR，0.8(P=0.049；95%CI，0.7~1.0)，氯吡格雷：HR，0.6(P=0.032；95%CI，0.4~1.0)。仅仅因为高龄而导致中风风险的老年患者冠状动脉搭桥术的下降是值得商榷的。(笔划。2012；43：38-43。)
Background and Purpose-The risk of stroke after coronary artery bypass grafting (CABG) is known to increase dramatically with age. During recent years, the age of patients operated on has increased and concomitant therapy has changed. Therefore, we have re-evaluated the risk of stroke after CABG.Methods-Through the Danish National Hospital Register, we identified all 25 159 patients with isolated CABG from 1997 through 2006. Stroke, comorbidities, and medication were further obtained. Risk factors of stroke were determined through regression models.Results-Overall, 1901 patients (7.6%) suffered a stroke after surgery, 477 patients (2.0%) within 30 days after CABG. Rates of stroke per 100 person-years (95% CI) within 30 days after surgery increased with age: = 80 years, 38.0 (25.2-57.1). Risks of stroke within 30 days after surgery adjusted for age (reference: age = 80 years: HR, 3.0 (P=0.001; 95% CI, 1.8-4.9), previous stroke: HR, 4.2 (P=0.001; 95% CI, 3.3-5.4), diabetes: HR, 1.3 (P=0.019; 95% CI, 1.1-1.7), hypertension: HR, 1.4 (P=0.003; 95% CI, 1.1-1.7), peripheral vascular disease: HR, 1.6 (P=0.001; 95% CI, 1.3-2.1), renal failure: HR, 1.7 (P=0.012; 95% CI, 1.1-2.5), statins: HR, 0.8 (P=0.049; 95% CI, 0.7-1.0), clopidogrel: HR, 0.6 (P=0.032; 95% CI, 0.4-1.0).Conclusions-The increase in stroke with age after CABG is moderate and the relation uncertain in ages older than 70 years. Declining CABG in elderly patients because of risk of stroke purely on the basis of high age is debatable. (Stroke. 2012;43:38-43.)