Likosky Donald S, Dacey Lawrence J, Baribeau Yvon R, Leavitt Bruce J, Clough Robert, Cochran Richard P, Quinn Reed, Sisto Donato A, Charlesworth David C, Malenka David J, MacKenzie Todd A, Olmstead Elaine M, Ross Cathy S, O'Connor Gerald T
Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
Ann Thorac Surg. 2008 Apr;85(4):1233-7. doi: 10.1016/j.athoracsur.2007.12.066.
Increasing numbers of the very elderly are undergoing coronary artery bypass graft surgery (CABG). Short-term results have been studied, but few data are available concerning long-term outcomes.
We conducted a cohort study of 54,397 consecutive patients undergoing primary, isolated CABG surgery between July 1, 1987, and June 30, 2006. Patient records were linked to the Social Security Administration's Death Master File.
During 390,871 person-years of follow-up, there were 17,352 deaths. There were 51,149 patients younger than 80 years, 2,661 patients aged 80 to 84 years, and 587 patients aged 85 or more years who underwent isolated CABG surgery. Crude in-hospital survival was 97.2% for those less than 80 years, 98.3% for those aged 80 to 84 years, and 87.6% for those aged 85 or more years. Patients aged 80 or more years were more likely to be female (46.9%), more likely to be emergency priority (10.2%), and more likely to have associated comorbidities than younger patients. Patients aged 85 or more years were more likely to have intraoperative and postoperative morbid events. Among patients younger than 80, median survival was 14.4 years with an annual incidence of death of 4.2%. Among patients 80 to 84 years old, median survival time was 7.4 years, with an annual incidence rate of death of 10.3%. Among patients aged 85 or more years, median survival was 5.8 years, and the annual incidence of death was 13.7%.
Although very elderly CABG patients have more comorbidities and more acute presentation than younger patients and their in-hospital mortality rate is high, their long-term survival is surprisingly good.
接受冠状动脉旁路移植术（CABG）的高龄患者数量不断增加。已对短期结果进行了研究，但关于长期预后的数据却很少。
我们对1987年7月1日至2006年6月30日期间连续接受初次单纯CABG手术的54397例患者进行了队列研究。患者记录与社会保障管理局的死亡主文件相关联。
在390871人年的随访期间，有17352例死亡。有51149例年龄小于80岁的患者、2661例年龄在80至84岁之间的患者以及587例年龄在85岁及以上的患者接受了单纯CABG手术。年龄小于80岁者的院内粗生存率为97.2%，年龄在80至84岁者为98.3%，年龄在85岁及以上者为87.6%。80岁及以上的患者比年轻患者更可能为女性（46.9%）、更可能为急诊优先（10.2%）且更可能有合并症。年龄在85岁及以上的患者更可能发生术中和术后不良事件。在年龄小于80岁的患者中，中位生存期为14.4年，年死亡率为4.2%。在80至84岁的患者中，中位生存时间为7.4年，年死亡率为10.3%。在年龄在85岁及以上的患者中，中位生存期为5.8年，年死亡率为13.7%。
尽管高龄CABG患者比年轻患者有更多的合并症且病情更急，其院内死亡率较高，但其长期生存情况出人意料地良好。
