80 岁以上老年人冠状动脉旁路移植术：长期结果可能好于预期。
Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected.
机构信息
Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.
出版信息
Ann Thorac Surg. 2010 Apr;89(4):1119-24. doi: 10.1016/j.athoracsur.2009.12.063.
BACKGROUND
We have reviewed our experience with octogenarians undergoing coronary artery bypass grafting.
METHODS
A consecutive series of 274 patients age 80 years or greater out of 3,474 patients who underwent isolated coronary artery bypass grafting. We have assessed the intrinsic risk aged 80 years or greater by comparing them with a propensity score-matched cohort of younger patients with similar operative risk (other than age).
RESULTS
Thirty-day mortality (4.7% vs 1.3%, p<0.0001), combined adverse event rates (13.1% vs 6.6%, p<0.0001), and five-year survival (76.6% vs 90.4%, p<0.0001) were significantly poorer among patients aged 80 years or greater as compared with younger patients. These figures were, however, better than estimates of a recent systematic review by McKellar and colleagues (McKellar SH, Brown ML, Frye RL, Schaff HV, Sundt TM III. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat Clin Pract Cardiovasc Med 2008;5:738-46) (30-day mortality 7.2%, and five-year survival, 68%). When octogenarians were compared with 273 propensity score-matched patients aged less than 80 years, the 30-day mortality (4.8% vs 2.6%, p=0.17) and combined adverse event rates (13.2% vs 10.6%, p=0.36) did not significantly differ. Five-year survival, despite statistical significance, was not remarkably lower than that of propensity-matched patients aged less than 80 years (77.0% vs 81.3%, p=0.009). The decrease in survival of octogenarians was evident only during the first few months after surgery, but not later on.
CONCLUSIONS
The results of this study suggest that immediate and five-year survival of octogenarians undergoing coronary artery bypass grafting may be even better than previously estimated. Survival of octogenarians may be suboptimal only during the first few months after surgery, whereas at five years may not differ remarkably from younger patients with otherwise similar operative risk.
背景
我们回顾了 80 岁以上患者行冠状动脉旁路移植术的经验。
方法
连续对 3474 例行单纯冠状动脉旁路移植术的患者中 274 例 80 岁或 80 岁以上患者进行评估。我们通过比较年龄匹配的具有相似手术风险（除年龄外）的年轻患者队列，评估了 80 岁及以上患者的固有风险。
结果
与年轻患者相比，80 岁及以上患者 30 天死亡率（4.7% vs. 1.3%，p<0.0001）、综合不良事件发生率（13.1% vs. 6.6%，p<0.0001）和 5 年生存率（76.6% vs. 90.4%，p<0.0001）显著较差。然而，这些数据优于 McKellar 及其同事最近的系统评价（McKellar SH、Brown ML、Frye RL、Schaff HV、Sundt TM III. 比较 80 岁以上患者的冠状动脉血运重建术：系统评价和荟萃分析。Nat Clin Pract Cardiovasc Med 2008;5:738-46）（30 天死亡率为 7.2%，5 年生存率为 68%）。当 80 岁以上患者与 273 例年龄小于 80 岁的倾向评分匹配患者相比时，30 天死亡率（4.8% vs. 2.6%，p=0.17）和综合不良事件发生率（13.2% vs. 10.6%，p=0.36）差异无统计学意义。尽管有统计学意义，但 5 年生存率并未明显低于年龄小于 80 岁的倾向评分匹配患者（77.0% vs. 81.3%，p=0.009）。80 岁以上患者的生存率下降仅在手术后的前几个月明显，但此后并不明显。
结论
本研究结果表明，80 岁以上患者行冠状动脉旁路移植术的近期和 5 年生存率可能优于之前估计。只有在手术后的前几个月，80 岁以上患者的生存率才可能不佳，而在 5 年时，其生存率可能与具有相似手术风险的年轻患者无显著差异。
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