Efird Jimmy T, O'Neal Wesley T, Gouge Catherine A, Kindell Linda C, Kennedy Whitney L, Bolin Paul, O'Neal Jason B, Anderson Curtis A, Rodriguez Evelio, Ferguson T Bruce, Chitwood W Randolph, Kypson Alan P
Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA ; Center for Health Disparity Research, East Carolina University, USA.
Department of Cardiovascular Sciences, East Carolina Heart Institute, 115 Heart Drive, Greenville, NC 27834, USA.
Int J Cardiovasc Res. 2013 Mar 13;2(6). doi: 10.4172/2324-8602.1000154.
Cardiovascular disease is the leading cause of morbidity and mortality in patients on hemodialysis. To our knowledge, no studies have examined long-term outcomes of hemodialysis patients following coronary artery bypass grafting (CABG) in a predominately rural, low-income, and racially dichotomous population.
Long-term survival of hemodialysis patients undergoing non-emergent, isolated CABG was compared with non-hemodialysis patients. Survival probabilities were computed using the Kaplan-Meier product limit method and stratified by hemodialysis. Hazard ratios (HR) and 95% confidence intervals (95%CI) were computed using a Cox regression model.
Hemodialysis patients (n=220) had shorter long-term survival than non-hemodialysis patients (median survival=3.3 versus 14 years, p<0.0001). The survival difference remained statistically significant after adjusting for clinically relevant variables (HR=5.2, 95%CI=4.4-6.2).
Hemodialysis patients had significantly shorter long-term survival compared with non-hemodialysis patients after CABG. Further research is needed to address the cost and policy implications of our findings, especially among priority populations.
心血管疾病是血液透析患者发病和死亡的主要原因。据我们所知，尚无研究在以农村为主、低收入且种族二分的人群中考察冠状动脉旁路移植术（CABG）后血液透析患者的长期预后。
将接受非急诊、单纯CABG的血液透析患者的长期生存率与非血液透析患者进行比较。使用Kaplan-Meier乘积限法计算生存概率，并按血液透析进行分层。使用Cox回归模型计算风险比（HR）和95%置信区间（95%CI）。
血液透析患者（n = 220）的长期生存率低于非血液透析患者（中位生存期 = 3.3年对14年，p < 0.0001）。在对临床相关变量进行调整后，生存差异仍具有统计学意义（HR = 5.2，95%CI = 4.4 - 6.2）。
与非血液透析患者相比，如果接受CABG，血液透析患者的长期生存率显著缩短。需要进一步研究以探讨我们研究结果的成本和政策影响，尤其是在优先人群中。
