Biancari Fausto, Kangasniemi Olli-Pekka, Aliasim Mahar Muhammad, Rasinaho Elsi, Satomaa Antti, Tiozzo Valentina, Niemelä Matti, Lepojärvi Martti
Department of Surgery, Division of Cardio-thoracic and Vascular Surgery, Oulu University Hospital, Oulu, Finland.
Interact Cardiovasc Thorac Surg. 2009 Jan;8(1):40-4. doi: 10.1510/icvts.2007.173922. Epub 2008 May 21.
The aim of the present study was to evaluate the changing risk of patients undergoing coronary artery bypass grafting (CABG). Residents of Oulu who underwent coronary angiography and/or revascularization from 1993 to 2006 formed the basis of this community-wide study. One thousand three hundred and forty-nine consecutive patients who underwent CABG have been included in the analysis on changing operative risk and results after CABG. A significant increase in the operative risk occurred in patients who underwent CABG (mean logistic EuroSCORE in 1278 patients: 1993-1997: 3.7%; 1998-2002: 4.6%; 2003-2006: 5.4%; P<0.0001). Thirty-day mortality decreased during the last period (1993-1997: 2.5%; 1998-2002: 3.0%; 2003-2006: 1.6%; P=0.49). The area under the ROC curve of logistic EuroSCORE (1993-1997: 0.86; 1998-2002: 0.78; 2003-2006: 0.99) for prediction of 30-day postoperative mortality markedly improved during the last study period. Despite the increased operative risk, off-pump coronary surgery was associated with lower immediate postoperative mortality rates. Contrary to on-pump surgery, immediate postoperative death occurred after off-pump surgery only in patients with additive EuroSCORE >or=6. The results of this study suggest that improved perioperative care as well as changes in operative strategy are positively faced with the increased burden of comorbidities and operative risk of patients currently undergoing CABG.
本研究的目的是评估接受冠状动脉旁路移植术（CABG）患者的风险变化。1993年至2006年期间在奥卢接受冠状动脉造影和/或血运重建的居民构成了这项全社区研究的基础。1349例连续接受CABG的患者被纳入CABG手术风险变化及术后结果的分析。接受CABG的患者手术风险显著增加（1278例患者的平均逻辑欧洲心脏手术风险评估系统评分：1993 - 1997年：3.7%；1998 - 2002年：4.6%；2003 - 2006年：5.4%；P<0.0001）。最后一个时期30天死亡率有所下降（1993 - 1997年：2.5%；1998 - 2002年：3.0%；2003 - 2006年：1.6%；P = 0.49）。用于预测术后30天死亡率的逻辑欧洲心脏手术风险评估系统评分的ROC曲线下面积在最后一个研究时期显著改善（1993 - 1997年：0.86；1998 - 2002年：0.78；2003 - 2006年：0.99）。尽管手术风险增加，但非体外循环冠状动脉手术与较低的术后即刻死亡率相关。与体外循环手术相反，非体外循环手术后即刻死亡仅发生在相加欧洲心脏手术风险评估系统评分≥6的患者中。本研究结果表明，围手术期护理的改善以及手术策略的改变积极应对了当前接受CABG患者合并症负担和手术风险的增加。
