Ferguson T Bruce, Hammill Bradley G, Peterson Eric D, DeLong Elizabeth R, Grover Frederick L
The Society of Thoracic Surgeons National Database Committee, Chicago, Illinois, USA.
Ann Thorac Surg. 2002 Feb;73(2):480-9; discussion 489-90. doi: 10.1016/s0003-4975(01)03339-2.
The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999.
Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval.
Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients' predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality.
Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, CABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.
胸外科医师协会国家成人心脏数据库是医学领域最大的自愿临床数据库。利用该数据库，我们研究了1990年至1999年这十年间接受单纯冠状动脉旁路移植术（CABG）患者的风险状况变化及其手术结果。
追踪了这十年间CABG病例的23项术前风险因素的变化趋势。使用多变量逻辑风险模型，我们还确定了在这10年期间手术风险和风险调整后的手术死亡率的变化程度。
1990年至1999年期间，胸外科医师协会国家成人心脏数据库收集了在美国和加拿大522个胸外科医师协会参与机构进行的单纯CABG手术的1,154,486例患者记录。随着时间的推移，CABG患者年龄更大（1990年平均年龄63.7岁，1999年65.1岁）、女性比例更高（1990年女性占25.7%，1999年占28.7%），且更有可能有吸烟、糖尿病、肾衰竭、高血压、中风、慢性肺病、纽约心脏协会心功能IV级和三支血管病变病史（p < 0.0001）。患者的预测手术风险增加了30.1%，从1990年的2.6%增至1999年的3.4%。尽管风险更高，但实际手术死亡率下降了23.1%，从1990年的3.9%降至1999年的3.0%（p < 0.0001）。在这十年间，老年医疗保险年龄组（n = 629,174）的风险也有类似增加，死亡率下降。
接受单纯CABG手术的患者比十年前年龄更大、病情更重、风险更高。尽管如此，CABG死亡率已大幅下降。这些结果突出了过去十年间在CABG患者护理方面取得的卓越进展。
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