Efird Jimmy T, Griffin William F, Sarpong Daniel F, Davies Stephen W, Vann Iulia, Koutlas Nathaniel T, Anderson Ethan J, Crane Patricia B, Landrine Hope, Kindell Linda, Iqbal Zahra J, Ferguson T Bruce, Chitwood W Randolph, Kypson Alan P
Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina Heart Institute, East Carolina University, Greenville, NC 27834, USA.
Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
Int J Environ Res Public Health. 2015 Jul 6;12(7):7478-90. doi: 10.3390/ijerph120707478.
The aim of this study was to examine racial differences in long-term mortality after coronary artery bypass grafting (CABG), stratified by preoperative use of inotropic agents. Black and white patients who required preoperative inotropic support prior to undergoing CABG procedures between 1992 and 2011 were compared. Mortality probabilities were computed using the Kaplan-Meier product-limit method. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 15,765 patients underwent CABG, of whom 211 received preoperative inotropic agents within 48 hours of surgery. Long-term mortality differed by race (black versus white) among preoperative inotropic category (inotropes: adjusted HR = 1.6, 95% CI = 1.009-2.4; no inotropes: adjusted HR = 1.15, 95% CI = 1.08-1.2; P(interaction) < 0.0001). Our study identified an independent preoperative risk-factor for long-term mortality among blacks receiving CABG. This outcome provides information that may be useful for surgeons, primary care providers, and their patients.
本研究的目的是，按术前是否使用正性肌力药物进行分层，探讨冠状动脉旁路移植术（CABG）后长期死亡率的种族差异。对1992年至2011年间接受CABG手术前需要术前正性肌力支持的黑人和白人患者进行了比较。使用Kaplan-Meier乘积限法计算死亡率概率。使用Cox回归模型计算风险比（HR）和95%置信区间（CI）。共有15765例患者接受了CABG手术，其中211例在手术48小时内接受了术前正性肌力药物治疗。术前正性肌力药物类别中，长期死亡率存在种族差异（黑人与白人）（使用正性肌力药物：调整后HR = 1.6，95% CI = 1.009 - 2.4；未使用正性肌力药物：调整后HR = 1.15，95% CI = 1.08 - 1.2；P（交互作用）< 0.0001）。我们的研究确定了接受CABG手术的黑人患者长期死亡的一个独立术前危险因素。这一结果为外科医生、初级保健提供者及其患者提供了可能有用的信息。
