University of California, Davis Medical Center, Sacramento, California 95817, USA.
Ann Thorac Surg. 2012 Apr;93(4):1167-72. doi: 10.1016/j.athoracsur.2011.12.033. Epub 2012 Feb 22.
Coronary artery bypass grafting (CABG) is no longer rare for elderly patients. This study evaluates operative mortality and the effects of off-pump CABG (OPCAB) on mortality for elderly Californians between 2003 and 2008.
All isolated CABGs in California for 2003 to 2008 were classified into cohorts by age: (1) younger than 75, (2) 75 to 84, and (3) 85 or older. Multivariable logistic regression models were developed for operative mortality. Trend analyses for observed and predicted mortality, and observed-to-expected mortality ratios were performed. The "recycled predictions" method was used to assess the effect of OPCAB on operative mortality.
Among 101,710 isolated CABGs between 2003 and 2008, 22.0% were in cohort 2 and 2.3% were in cohort 3. Predicted mortality was unchanged for cohorts 2 and 3 (all p > 0.05), but observed-to-expected mortality ratios declined from 0.958 to 0.633 for cohort 2 (p = 0.021) and from 1.027 to 0.965 for cohort 3 (p = 0.168). The proportion of OPCAB for patients aged 75 years or older increased from 25.0% to 29.1% between 2003 and 2008. The adjusted odds ratio for operative mortality for OPCAB in patients aged 75 years or older was 0.752 (95% confidence interval, 0.650 to 0.871; p < 0.001) compared with on-pump CABG for the same age cohort.
In California, overall predicted mortality was unchanged for elderly patients between 2003 and 2008, but operative mortality significantly decreased for patients aged 75 to 84. Improvement for CABG patients aged 85 years or older was insignificant. The increase in the number of OPCAB patients was associated with decreased mortality for elderly patients.
对于老年患者来说，冠状动脉旁路移植术（CABG）已不再罕见。本研究评估了 2003 年至 2008 年期间加利福尼亚州老年患者的手术死亡率以及非体外循环冠状动脉旁路移植术（OPCAB）对死亡率的影响。
将 2003 年至 2008 年期间所有在加利福尼亚州进行的孤立性 CABG 病例分为年龄组：（1）<75 岁，（2）75-84 岁，（3）85 岁或以上。采用多变量逻辑回归模型评估手术死亡率。进行了观察和预测死亡率的趋势分析，以及观察到的与预期的死亡率比值。使用“回收预测”方法评估 OPCAB 对手术死亡率的影响。
在 2003 年至 2008 年间进行的 101710 例孤立性 CABG 中，22.0%属于队列 2，2.3%属于队列 3。队列 2 和 3 的预测死亡率没有变化（均 p>0.05），但队列 2 的观察到的与预期的死亡率比值从 0.958 降至 0.633（p=0.021），队列 3 的观察到的与预期的死亡率比值从 1.027 降至 0.965（p=0.168）。2003 年至 2008 年间，75 岁或以上患者的 OPCAB 比例从 25.0%增加到 29.1%。与同期年龄组的体外循环 CABG 相比，75 岁或以上患者的 OPCAB 手术死亡率的调整比值比为 0.752（95%置信区间，0.650 至 0.871；p<0.001）。
在加利福尼亚州，2003 年至 2008 年期间，老年患者的总体预测死亡率保持不变，但 75-84 岁患者的手术死亡率显著下降。85 岁及以上患者的 CABG 改善效果不明显。OPCAB 患者数量的增加与老年患者死亡率的降低有关。
