Jönsson Anders, Hammar Niklas, Nordquist Tobias, Ivert Torbjörn
Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Eur J Cardiothorac Surg. 2006 Aug;30(2):311-7. doi: 10.1016/j.ejcts.2006.05.015. Epub 2006 Jul 7.
To analyse early and late mortality after coronary artery bypass grafting (CABG) in patients with and without left main coronary artery (LMCA) stenosis during the 30-year period 1970-1999.
A total of 1888 of 10,647 patients (18%) who underwent a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, during 1970-1999 had significant left main coronary artery stenosis. The Swedish National Cause of Death Register was used to determine mortality up to five years after the operation.
The proportion of patients with LMCA stenosis of all CABG patients increased from 7% during the 1970s to 26% in 1999. During 1970-1984 early mortality was 5.8% in patients with LMCA stenosis compared with 1.5% in patients without LMCA stenosis (odds ratio (OR) 3.7 (95% confidence interval (CI) 1.8-7.6)). The corresponding rates during 1995-1999 were 2.0% versus 2.2% (OR 0.8 (95% CI 0.5-1.5)), respectively. The increased risk of early death in patients with LMCA stenosis was neutralised in males during 1985-1994 and in females during 1995-1999. Five-year survival in males was 88% after operations performed during 1994-1999 compared with 82% after CABG performed during 1970-1984. Five-year mortality, exclusive of early deaths, during 1970-1984 was higher in patients with LMCA stenosis (12.8%) than in those without (8.4%) (relative risk 1.7 (95% CI 1.1-2.5)). An increased risk of late mortality in patients with LMCA stenosis was neutralised in males during 1985-1994 and in females during 1995-1999.
During 1970-1999 there was a decrease of early and five-year mortality in patients with LMCA stenosis after CABG despite increase of patient age and risk factors. There were gender differences so that the risk of death in patients with compared with in those without LMCA stenosis was neutralised in males during 1985-1994 and in females during 1994-1999. The continuous decline of mortality during three decades most likely reflects improvement of the peri- and postoperative management of patients undergoing CABG during this period.
分析1970年至1999年这30年间，有和没有左主干冠状动脉（LMCA）狭窄的患者在冠状动脉旁路移植术（CABG）后的早期和晚期死亡率。
1970年至1999年期间，在瑞典斯德哥尔摩的卡罗林斯卡医院首次接受单纯CABG手术的10647例患者中，共有1888例（18%）存在显著的左主干冠状动脉狭窄。使用瑞典国家死亡原因登记册确定术后五年内的死亡率。
所有CABG患者中，LMCA狭窄患者的比例从20世纪70年代的7%增加到1999年的26%。在1970 - 1984年期间，LMCA狭窄患者的早期死亡率为5.8%，而无LMCA狭窄患者为1.5%（优势比（OR）3.7（95%置信区间（CI）1.8 - 7.6））。1995 - 1999年期间相应的比率分别为2.0%和2.2%（OR 0.8（95% CI 0.5 - 1.5））。1985 - 1994年期间男性和1995 - 1999年期间女性中，LMCA狭窄患者早期死亡风险增加的情况得到了中和。1994 - 1999年期间手术的男性患者五年生存率为88%，而1970 - 1984年进行CABG手术后的生存率为82%。1970 - 1984年期间，不包括早期死亡的五年死亡率，LMCA狭窄患者（12.8%）高于无狭窄患者（8.4%）（相对风险1.7（95% CI 1.1 - 2.5））。1985 - 1994年期间男性和1995 - 1999年期间女性中，LMCA狭窄患者晚期死亡风险增加的情况得到了中和。
在1970 - 1999年期间，尽管患者年龄和风险因素增加，但CABG术后LMCA狭窄患者的早期和五年死亡率有所下降。存在性别差异，在1985 - 1994年期间男性和1994 - 1999年期间女性中，与无LMCA狭窄患者相比，有狭窄患者的死亡风险得到了中和。三十年期间死亡率的持续下降很可能反映了这一时期接受CABG手术患者围手术期和术后管理的改善。
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