Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
J Thorac Cardiovasc Surg. 2012 Feb;143(2):273-81. doi: 10.1016/j.jtcvs.2011.10.029.
Coronary artery bypass grafting (CABG) is the operation most commonly performed by cardiac surgeons. There are few contemporary data examining evolving patient characteristics and surgical outcomes of isolated CABG. We used the Society of Thoracic Surgeons adult cardiac surgery database to characterize trends in patient characteristics and outcomes after CABG over the past decade.
From 2000 to 2009, 1,497,254 patients underwent isolated primary CABG at Society of Thoracic Surgeons participating institutions. Demographics, operative characteristics, and postoperative outcomes were assessed, and risk-adjusted outcomes were calculated.
Compared with the year 2000, patients undergoing isolated primary CABG in 2009 were more likely to have diabetes mellitus (33% vs 40%) and hypertension (71% vs 85%). There were clinically insignificant differences in age, gender, and body surface area. Between 2000 and 2009, there has been a 6.3% and 19.5% increase in the preoperative use of aspirin and beta-blockers, respectively. Between 2004 and 2009, there was a 7.8% increase in the use of angiotension-converting enzyme inhibitors preoperatively. Furthermore, between 2005 and 2009 there was a 3.8% increase in the use of statins preoperatively. The median number of distal anastomoses performed was unchanged between 2000 and 2009 (3; interquartile range, 2-4). There was a significant increase in the use of the internal thoracic artery (88% in 2000 vs 95% in 2009). The predicted mortality rates of 2.3% were consistent between 2000 and 2009. The observed mortality rate over this period declined from 2.4% in 2000 to 1.9% in 2009 representing a relative risk reduction of 24.4%. The incidence of postoperative stroke decreased significantly from 1.6% to 1.2%, representing a risk reduction of 26.4%. There was also a 9.2% relative reduction in the risk of reoperation for bleeding and a 32.9% relative risk reduction in the incidence of sternal wound infection.
Over the past decade, the risk profile of patients undergoing CABG has changed, with fewer smokers, more diabetic patients, and better medical therapy characterizing patients referred for surgical coronary revascularization. The left internal thoracic artery is nearly universally used and outcomes have improved substantially, with a significant decline in postoperative mortality and morbidity.
冠状动脉旁路移植术（CABG）是心脏外科医生最常进行的手术。目前很少有关于孤立性 CABG 患者特征和手术结果演变的当代数据。我们使用胸外科医生学会成人心脏手术数据库，描述过去十年中 CABG 患者特征和结果的趋势。
2000 年至 2009 年，胸外科医生学会参与机构的 1497254 例患者接受了单纯原发性 CABG。评估了人口统计学、手术特征和术后结果，并计算了风险调整后的结果。
与 2000 年相比，2009 年接受单纯原发性 CABG 的患者更有可能患有糖尿病（33% vs 40%）和高血压（71% vs 85%）。年龄、性别和体表面积的差异较小。2000 年至 2009 年，术前阿司匹林和β受体阻滞剂的使用分别增加了 6.3%和 19.5%。2004 年至 2009 年，术前血管紧张素转换酶抑制剂的使用率增加了 7.8%。此外，2005 年至 2009 年，术前他汀类药物的使用率增加了 3.8%。2000 年至 2009 年，远端吻合术的中位数保持不变（3；四分位距，2-4）。内乳动脉的使用率显著增加（2000 年为 88%，2009 年为 95%）。2000 年至 2009 年，预测死亡率为 2.3%，保持一致。在此期间，观察到的死亡率从 2000 年的 2.4%下降到 2009 年的 1.9%，相对风险降低 24.4%。术后中风的发生率显著下降，从 1.6%下降到 1.2%，风险降低 26.4%。出血再次手术的风险相对降低 9.2%，胸骨伤口感染的相对风险降低 32.9%。
在过去十年中，接受 CABG 的患者风险状况发生了变化，接受手术冠状动脉血运重建的患者中吸烟者减少，糖尿病患者增多，药物治疗效果更好。左内乳动脉几乎普遍使用，结果有了显著改善，术后死亡率和发病率显著下降。
