Department of Cardiothoracic Surgery, Athens University School of Medicine, Attikon University Hospital, Athens, Greece.
Ann Thorac Surg. 2010 Apr;89(4):1112-8. doi: 10.1016/j.athoracsur.2010.01.009.
Chronic obstructive pulmonary disease (COPD) has been conventionally associated with increased operative mortality and morbidity after coronary artery bypass grafting. Some studies, however, challenge this association. Moreover, the effect of COPD on long-term survival after coronary artery bypass grafting has not been adequately assessed. Thus, in this clinical setting, both early and late outcome require further examination.
We studied 3,760 consecutive patients who underwent isolated coronary artery bypass grafting between 1992 and 2002. The propensity for COPD was determined by logistic regression analysis, and each patient with COPD was matched with 3 patients without COPD. Matched groups were compared for early outcome and long-term survival (mean follow-up, 7.6 years). Long-term survival data were obtained from the National Death Index.
There were 550 patients (14.6%) with COPD. Multivariate analysis showed that patients with COPD were older and sicker. However, propensity-matched groups did not differ in terms of hospital mortality or major morbidity, although COPD was associated with a slightly longer hospital stay. In contrast, COPD patients had increased long-term mortality, with a hazard ratio of 1.28 (95% confidence intervals, 1.11 to 1.47; p=0.001). Freedom from all-cause mortality at 7 years after CABG was 65% and 72% in matched patients with and without COPD, respectively (p=0.008). In patients with COPD, the hazard estimate was consistently increased up to 9 years postoperatively.
Chronic obstructive pulmonary disease, although not an independent predictor of increased early mortality and morbidity in this series, is a continuing detrimental risk factor for long-term survival.
慢性阻塞性肺疾病（COPD）与冠状动脉旁路移植术后手术死亡率和发病率增加有关。然而，一些研究对这种关联提出了质疑。此外，COPD 对冠状动脉旁路移植术后长期生存的影响尚未得到充分评估。因此，在这种临床情况下，早期和晚期结果都需要进一步检查。
我们研究了 1992 年至 2002 年间接受单纯冠状动脉旁路移植术的 3760 例连续患者。COPD 的倾向通过逻辑回归分析确定，每个 COPD 患者匹配 3 名无 COPD 患者。比较匹配组的早期结果和长期生存（平均随访 7.6 年）。长期生存数据来自国家死亡指数。
有 550 例患者（14.6%）患有 COPD。多变量分析显示，COPD 患者年龄较大，病情较重。然而，倾向匹配组在住院死亡率或主要发病率方面没有差异，尽管 COPD 与住院时间略长有关。相比之下，COPD 患者的长期死亡率增加，风险比为 1.28（95%置信区间，1.11 至 1.47；p=0.001）。CABG 后 7 年时，匹配患者的无全因死亡率分别为 65%和 72%（p=0.008）。在 COPD 患者中，风险估计值一直增加到术后 9 年。
虽然在本系列中 COPD 不是增加早期死亡率和发病率的独立预测因素，但它是长期生存的持续不利危险因素。
