既往房颤作为终末期肾病患者心脏手术晚期死亡率的预测因素——一项多中心研究

Preexisting atrial fibrillation as predictor for late-time mortality in patients with end-stage renal disease undergoing cardiac surgery--a multicenter study.

作者信息

Schönburg M, Ziegelhoeffer T, Weinbrenner F, Bechtel M, Detter C, Krabatsch T, Osswald B, Riess F C, Scholz F, Stamm C, Sievers H H, Bartels C

机构信息

Cardiac Surgery, Kerckhoff Klinik, Benekestrasse 2-8, Bad Nauheim, Germany.

出版信息

Thorac Cardiovasc Surg. 2008 Apr;56(3):128-32. doi: 10.1055/s-2007-989432.

DOI:10.1055/s-2007-989432

PMID:18365969

Abstract

BACKGROUND

Although patients with end-stage renal disease (ESRD) are considered to be high-risk patients in cardiac surgery, the reported studies are rather small, resulting in unsatisfactory analyses of outcome determinants. Therefore, we aimed to identify possible risk factors, with a particular focus on the impact of pre-existing atrial fibrillation (AF) on the postoperative short-term and long-term mortality of ESRD patients undergoing cardiac surgery.

METHODS

In a multicenter study 522 patients with ESRD undergoing CABG only (62.9 %), valve surgery only (17.2 %), or both (19.9 %) with comparable demographic and other cardiac risk factor characteristics were investigated retrospectively over a period of 10 years. The outcome was divided into perioperative (within 30 days) and late morbidity and mortality, and multivariate analysis was performed for both.

RESULTS

The mean perioperative mortality was 11.5 % and the 5-year survival rate was 42 %. Emergency surgery, insulin-dependent diabetes mellitus, the number of vein grafts and age were identified as risk factors whereas complete revascularization, the use of an internal thoracic artery and the presence of sinus rhythm were identified as beneficial factors for long-term survival. 14.1 % of all patients had pre-existing AF. Although AF was not identified as an independent risk factor for perioperative mortality ( P = 0.59), it was identified as an independent predictor for late mortality ( P < 0.001). Median survival of patients without AF was 1816 days, while for patients with AF it was only 715 days.

CONCLUSIONS

AF does represent an independent predictor for long-term but not perioperative mortality in patients with ESRD. However, effective treatment of AF is controversially discussed. Anticoagulation therapy or perioperative ablation of the arrhythmia should be considered in order to improve the survival of these patients.

摘要

背景

尽管终末期肾病（ESRD）患者在心脏手术中被视为高危患者，但已报道的研究规模较小，导致对结局决定因素的分析不尽人意。因此，我们旨在确定可能的风险因素，特别关注既往心房颤动（AF）对接受心脏手术的ESRD患者术后短期和长期死亡率的影响。

方法

在一项多中心研究中，对522例ESRD患者进行了回顾性研究，这些患者仅接受冠状动脉旁路移植术（CABG）（62.9%）、仅接受瓣膜手术（17.2%）或两者都接受（19.9%），研究持续了10年，患者的人口统计学特征和其他心脏危险因素具有可比性。结局分为围手术期（30天内）以及晚期发病率和死亡率，并对两者进行多变量分析。

结果

围手术期平均死亡率为11.5%，5年生存率为42%。急诊手术、胰岛素依赖型糖尿病、静脉移植物数量和年龄被确定为风险因素，而完全血运重建、使用胸廓内动脉和窦性心律的存在被确定为长期生存的有利因素。所有患者中有14.1%既往有AF。虽然AF未被确定为围手术期死亡率的独立危险因素（P = 0.59），但它被确定为晚期死亡率的独立预测因素（P < 0.001）。无AF患者的中位生存期为1816天，而有AF患者仅为715天。