Argenziano M, Spotnitz H M, Whang W, Bigger J T, Parides M, Rose E A
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Circulation. 1999 Nov 9;100(19 Suppl):II119-24. doi: 10.1161/01.cir.100.suppl_2.ii-119.
Preoperative characteristics may influence morbidity and mortality in patients undergoing coronary artery bypass grafting (CABG). The CABG Patch Trial was designed to assess the impact of prophylactic insertion of an implantable cardioverter-defibrillator in patients undergoing high-risk CABG. This database was used to investigate the influence of symptomatic congestive heart failure (CHF) and angina on morbidity and mortality in CABG patients with ventricular dysfunction.
Data were analyzed for 900 randomized patients with an ejection fraction </=35% and an abnormal signal-averaged ECG. Single-variable and stepwise multiple logistic regression analyses were used for mortality and length-of-stay (LOS) data. Severity of CHF and angina was graded by the New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) classifications, respectively. Perioperative mortality was 3.5% in 454 patients without clinical signs of heart failure versus 7.7% in 443 patients with NYHA class I to IV heart failure (P=0.018). By multiple logistic regression analysis, mortality was significantly higher in patients with preoperative symptomatic (NYHA class I to IV) heart failure (odds ratio, 2.4; P=0.01) or reoperation (odds ratio, 3.8; P<0.0001). Mortality was not significantly influenced by age, sex, the presence or severity of angina, hypertension, left main coronary artery disease, pulmonary disease, or severity of CHF (although LOS was increased 0.7 days per NYHA class). Patients with a history of stroke had a higher rate of perioperative stroke (16.4% versus 3.6%, P=0.001) and an increased LOS (by 3.5 days).
Symptomatic heart failure and reoperation are predictors of increased operative mortality in patients with ventricular dysfunction and a positive signal-averaged ECG. Conversely, patients without heart failure symptoms may undergo CABG with relatively low mortality despite low ejection fraction. LOS is prolonged significantly by advanced age, history of stroke, and the presence and severity of heart failure.
术前特征可能会影响接受冠状动脉旁路移植术（CABG）患者的发病率和死亡率。CABG贴片试验旨在评估在接受高危CABG的患者中预防性植入植入式心脏复律除颤器的影响。该数据库用于研究有症状的充血性心力衰竭（CHF）和心绞痛对心室功能障碍的CABG患者发病率和死亡率的影响。
对900例射血分数≤35%且信号平均心电图异常的随机患者的数据进行了分析。单变量和逐步多因素逻辑回归分析用于死亡率和住院时间（LOS）数据。CHF和心绞痛的严重程度分别根据纽约心脏协会（NYHA）和加拿大心血管学会（CCS）的分类进行分级。454例无心力衰竭临床体征的患者围手术期死亡率为3.5%，而443例NYHA I至IV级心力衰竭患者的围手术期死亡率为7.7%（P=0.018）。通过多因素逻辑回归分析，术前有症状（NYHA I至IV级）心力衰竭患者的死亡率显著更高（比值比，2.4；P=0.01）或再次手术患者的死亡率显著更高（比值比，3.8；P<0.0001）。死亡率不受年龄、性别、心绞痛的存在或严重程度、高血压、左主干冠状动脉疾病、肺部疾病或CHF严重程度的显著影响（尽管每增加一个NYHA分级LOS增加0.7天）。有中风病史的患者围手术期中风发生率更高（16.4%对3.6%，P=0.001）且LOS延长（延长3.5天）。
有症状的心力衰竭和再次手术是心室功能障碍且信号平均心电图阳性患者手术死亡率增加的预测因素。相反，无症状心力衰竭的患者尽管射血分数低，但接受CABG时死亡率相对较低。高龄、中风病史以及心力衰竭的存在和严重程度会显著延长LOS。
