Institute for Health Care Research and Improvement, Baylor Research Institute, Dallas, Texas 76206, USA.
Ann Thorac Surg. 2012 Jun;93(6):1943-8. doi: 10.1016/j.athoracsur.2012.02.072. Epub 2012 May 3.
Use of isolated coronary artery bypass grafting (CABG) is expected to increase as the population ages. Short-term adverse outcomes models and their application to the decision-making process have greatly increased the safety and effectiveness of CABG. However, similar tools addressing long-term survival have not been developed. We examined the effect of the preoperative risk factors included in short-term outcomes models on long-term survival in patients who survive CABG.
A Cox survival model considering preoperative risk factors identified by The Society of Thoracic Surgeons was developed for 8,529 consecutive patients who underwent isolated CABG between January 1, 1997, and August 31, 2010, at Baylor University Medical Center (Dallas, Texas) and were alive 30-days post-CABG.
There were 2,388 (27.9%) deaths during follow-up (≤14 years). Unadjusted survival was 83.8% and 65% at 5 and 10 years, respectively. The Cox model showed that most established preoperative risk factors were significantly associated with survival. Their effect was minimal, however; the variation explained by their cumulative effect in predicting survival was 16.8% (R2=0.168).
Established operative risk factors may not be good predictors of long-term post-CABG survival. Late mortality may be attributable to many causes, not necessarily related to patients' cardiovascular and general health at the time of operation. Discussions with cardiothoracic surgeons and long-term shared decision making with primary care physicians/cardiologists should therefore not focus solely on patients' preoperative risk profile but should also emphasize the importance of preventing/controlling other diseases through a healthy lifestyle and compliance with disease management protocols.
随着人口老龄化，孤立冠状动脉旁路移植术（CABG）的使用预计会增加。短期不良结果模型及其在决策过程中的应用极大地提高了 CABG 的安全性和有效性。然而，类似的针对长期生存的工具尚未开发。我们研究了短期结果模型中包含的术前危险因素对接受 CABG 治疗并存活的患者的长期生存的影响。
我们为 1997 年 1 月 1 日至 2010 年 8 月 31 日在德克萨斯州达拉斯贝勒大学医学中心接受孤立 CABG 的 8529 例连续患者开发了一个考虑术前危险因素的 Cox 生存模型，这些患者在 CABG 后 30 天存活。
在随访期间（≤14 年）有 2388 例（27.9%）死亡。未调整的生存率分别为 83.8%和 65%，分别在 5 年和 10 年。Cox 模型显示，大多数已确立的术前危险因素与生存率显著相关。然而，其影响很小；其累积效应预测生存率的变化解释为 16.8%（R2=0.168）。
既定的手术风险因素可能不是 CABG 后长期生存的良好预测指标。晚期死亡率可能归因于多种原因，不一定与患者手术时的心血管和整体健康状况有关。因此，与心胸外科医生的讨论和与初级保健医生/心脏病专家的长期共同决策不应仅侧重于患者的术前风险概况，还应强调通过健康的生活方式和遵守疾病管理方案来预防/控制其他疾病的重要性。
