Thorsteinsson Kristinn, Fonager Kirsten, Mérie Charlotte, Gislason Gunnar, Køber Lars, Torp-Pedersen Christian, Mortensen Rikke N, Andreasen Jan J
Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gentofte, Denmark.
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7. doi: 10.1093/ejcts/ezv060. Epub 2015 Feb 19.
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (≥80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients <60 years, 8% in octogenarians). The long-term mortality rate at 1 and 5 years was 2 and 7% (age <60 years) and 14 and 36% (age >80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
接受冠状动脉旁路移植术（CABG）的八旬老人数量日益增多。本研究旨在探讨CABG术后死亡率随时间的年龄依赖性趋势以及术前合并症情况。
纳入1996年1月至2012年12月在丹麦接受单纯CABG手术的所有患者。通过全国性行政登记册识别患者。将年龄分为五个不同组，时间分为三个时期，以观察死亡率和术前合并症是否随时间变化。在多变量Cox比例风险模型中分析30天死亡率的预测因素，并通过Kaplan-Meier曲线估计1年和5年生存率。
共纳入38830例患者；中位年龄为65.4±9.5岁，随时间增加至66.6±9.5岁。男性占80%。八旬老人有1488例（4%）。中位生存期分别为14.7年（60 - 69岁）、10.7年（70 - 74岁）、8.9年（75 - 79岁）和7.2年（≥80岁）。30天死亡率为3%，随年龄增加（<60岁患者为1%，八旬老人为8%）。1年和5年的长期死亡率在<60岁患者中分别为2%和7%，在>80岁患者中分别为14%和36%。在研究期间，>75岁患者的比例从10%增加到20%，接受急诊或紧急手术的患者比例也增加。所有年龄组的合并症负担随时间增加，例如充血性心力衰竭从13%增至17%，糖尿病从12%增至21%，中风从9%增至11%。年龄和急诊手术是30天死亡率的主要预测因素：年龄>80岁[风险比（HR）：5.75，95%置信区间（CI）：4.41 - 7.50]，急诊手术（HR：5.23，95%CI：4.38 - 6.25）。
手术时患者年龄越来越大，合并症负担比以前更重。接受急诊或紧急手术的患者比例随年龄和时间增加。尽管如此，30天死亡率随时间下降，长期生存率提高，但八旬老人的长期生存率稳定。与年轻患者相比，八旬老人的30天死亡率显著更高，但手术可在可接受风险和良好长期预后下进行。
