Järvinen Otso, Saarinen Timo, Julkunen Juhani, Huhtala Heini, Tarkka Matti R
Department of Cardiothoracic Surgery, Tampere University Hospital, Tampere, Finland.
Eur J Cardiothorac Surg. 2003 Nov;24(5):750-6. doi: 10.1016/s1010-7940(03)00413-5.
Improvement in survival and quality of life are the primary indications for coronary artery bypass graft (CABG) operations. Among elderly patients the main goal of surgery is not necessarily to prolong life, but to improve the health-related quality of life. Factors associated with mortality and morbidity following CABG surgery have been well defined, but the quality of life and functional capacity in elderly patients undergoing CABG are poorly documented. The aim here was to investigate changes in health-related quality of life, overall performance status and symptomatic status during 1 year after CABG surgery.
Comprehensive data on 508 CABG patients were prospectively collected, including preoperative risk factors and postoperative morbidity in a surgical center and in all eighteen secondary referral hospitals up to discharge. The RAND-36 Health Survey (RAND-36) was used as indicator of quality of life. The primary outcome was change in the physical component summary, mental component summary and General Health summary scores from the RAND-36. Karnofsky dependency category was used to assess overall performance status, and symptomatic status was estimated according to New York Heart Association (NYHA) class. All assessments were made preoperatively and repeated 12 months later. Analysis was based on three age groups: 64 years or less (282 patients), 65-74 years (175 patients), and 75 or more years (51 patients).
Thirty-day and 1-year survival rates were 98.2 and 96.7%, respectively. A great majority (86.4%) of the patients recovered without major complication. In all, the present data showed significant improvement in all eight domains of QOL as well as in functional capacity and NYHA class during the 1st year after CABG. However, the mean change in RAND-36 Mental Component Summary scores among patients aged 75 years or more did not reach a statistically significant level (P=0.097) and they had significantly minor improvement as compared to younger patients (P<0.05). Moreover, their General Health score improvement was poorer and statistically insignificant (P=0.817).
Elderly patients not only have higher mortality and morbidity but also derive less benefit from CABG regarding certain aspects of QOL.
提高生存率和生活质量是冠状动脉旁路移植术（CABG）的主要指征。在老年患者中，手术的主要目标不一定是延长生命，而是改善与健康相关的生活质量。CABG手术后与死亡率和发病率相关的因素已得到明确界定，但接受CABG的老年患者的生活质量和功能能力记录较少。本研究旨在调查CABG手术后1年内与健康相关的生活质量、总体表现状态和症状状态的变化。
前瞻性收集了508例CABG患者的综合数据，包括手术中心和所有18家二级转诊医院直至出院的术前危险因素和术后发病率。使用兰德36健康调查（RAND-36）作为生活质量指标。主要结局是RAND-36身体成分总结、心理成分总结和总体健康总结得分的变化。卡诺夫斯基依赖类别用于评估总体表现状态，症状状态根据纽约心脏协会（NYHA）分级进行评估。所有评估均在术前进行，并在12个月后重复进行。分析基于三个年龄组：64岁及以下（282例患者）、65-74岁（175例患者）和75岁及以上（51例患者）。
30天和1年生存率分别为98.2%和96.7%。绝大多数（86.4%）患者康复且无重大并发症。总体而言，目前的数据显示，CABG术后第1年，生活质量的所有八个领域以及功能能力和NYHA分级均有显著改善。然而，75岁及以上患者的RAND-36心理成分总结得分的平均变化未达到统计学显著水平（P=0.097），与年轻患者相比，他们的改善明显较小（P<0.05）。此外，他们的总体健康得分改善较差且无统计学意义（P=0.817）。
老年患者不仅死亡率和发病率较高，而且在生活质量的某些方面从CABG中获得的益处较少。
