Wu Chuntao, Camacho Fabian T, Culliford Alfred T, Gold Jeffrey P, Wechsler Andrew S, Higgins Robert S D, Lahey Stephen J, Smith Craig R, Jordan Desmond, Hannan Edward L
Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA 17033, USA.
Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):76-84. doi: 10.1161/CIRCOUTCOMES.111.963124. Epub 2012 Jan 10.
The survival difference between off-pump and on-pump coronary artery bypass graft surgery for follow-up longer than 5 years is not well-understood. The objective of this study is to examine the difference in 7-year mortality after these 2 procedures.
The state of New York's Cardiac Surgery Reporting System was used to identify the 2640 off-pump and 5940 on-pump patients discharged from July through December 2000. The National Death Index was used to ascertain patients' vital statuses through 2007. A logistic regression model was fit to predict the probability of receiving an off-pump procedure using baseline patient characteristics. Off-pump and on-pump patients were matched with a 1:1 ratio based on the probability of receiving an off-pump procedure. Kaplan-Meier survival curves for the 2 procedures were compared using the propensity-matched data, and the hazard ratio for death for off-pump in comparison with on-pump procedures was obtained. In subgroup analyses, the significance of interactions between type of surgery and baseline risk factors was tested. In this study, 2631 pairs of off-pump and on-pump patients were propensity matched. The 7-year Kaplan-Meier survival rates were 71.2% and 73.4% (P=0.07) for off-pump and on-pump surgery, respectively. The hazard ratio for death (off-pump versus on-pump) was 1.10 (95% confidence interval: 0.99 to 1.21, P=0.07). No statistical significance was detected for the interaction terms between the type of surgery and a number of different baseline risk factors.
The difference in long-term mortality between on-pump and off-pump coronary artery bypass graft surgery is not statistically significant.
非体外循环与体外循环冠状动脉旁路移植手术超过5年随访期的生存差异尚未完全明确。本研究的目的是探讨这两种手术7年死亡率的差异。
利用纽约州心脏手术报告系统确定2000年7月至12月出院的2640例非体外循环患者和5940例体外循环患者。通过国家死亡指数确定患者截至2007年的生命状态。采用逻辑回归模型，根据患者基线特征预测接受非体外循环手术的概率。基于接受非体外循环手术的概率，将非体外循环和体外循环患者按1:1的比例进行匹配。使用倾向匹配数据比较两种手术的Kaplan-Meier生存曲线，并获得非体外循环手术与体外循环手术相比的死亡风险比。在亚组分析中，检验手术类型与基线风险因素之间相互作用的显著性。本研究中，2631对非体外循环和体外循环患者进行了倾向匹配。非体外循环和体外循环手术的7年Kaplan-Meier生存率分别为71.2%和73.4%（P=0.07）。死亡风险比（非体外循环与体外循环）为1.10（95%置信区间：0.99至1.21，P=0.07）。未检测到手术类型与多种不同基线风险因素之间的交互项具有统计学显著性。
体外循环与非体外循环冠状动脉旁路移植手术的长期死亡率差异无统计学意义。
