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冠状动脉搭桥手术后,移植血管通畅与更高的健康相关生活质量相关。

Graft patency is associated with higher health-related quality of life after coronary artery bypass surgery.

作者信息

Samano Ninos, Bodin Lennart, Karlsson Jan, Geijer Håkan, Arbeus Mikael, Souza Domingos

机构信息

Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.

出版信息

Interact Cardiovasc Thorac Surg. 2017 Mar 1;24(3):388-394. doi: 10.1093/icvts/ivw372.

Abstract

OBJECTIVES

The objective of this study was to investigate whether graft patency was associated with higher health-related quality of life in coronary artery bypass grafting patients and to compare this study with the general Swedish population.

METHODS

Patients were included from 3 randomized trials and 1 prospective cohort trial. The generic health-related quality of life instrument, EQ-5D (VAS and index) was used. Graft patency was assessed with computed tomography angiography. Patients were divided into 2 groups according to the number of occluded distal anastomosis: Group I with no to 1 occlusion ( n  = 209) and Group II with 2 to 4 occlusions ( n  = 24).

RESULTS

Two hundred and thirty-three patients underwent computed tomography angiography at a mean of 7.5 (1-18) years post-operatively. The mean difference in EQ-VAS and EQ-5D index between Groups II and I after model adjustment was -19.8 (95% CI -25.3 to -14.3; P  < 0.001) and -0.13 (95% CI -0.19 to -0.08; P  < 0.001), respectively. The EQ-5D index for the study population was similar compared with the Swedish population, 0.851 and 0.832, respectively, with an effect-size of 0.112 (trivial). The EQ-5D index of the study population was higher compared with the ischemic heart disease group in the Swedish population, 0.851 vs 0.60, with an effect-size of 0.999 (large).

CONCLUSIONS

Graft patency was associated with higher health-related quality of life in coronary artery bypass patients. This patient group reported similar function and wellbeing compared to the general Swedish population and better health status than those in the same disease group in the general population.

CLINICAL REGISTRATION NUMBER

Clinicaltrials.gov: NCT02547194 and the Research and Development registry in Sweden: 167861.

摘要

目的

本研究的目的是调查冠状动脉搭桥术患者的移植血管通畅情况是否与更高的健康相关生活质量相关,并将本研究与瑞典普通人群进行比较。

方法

患者来自3项随机试验和1项前瞻性队列试验。使用了通用的健康相关生活质量工具EQ-5D(视觉模拟量表和指数)。通过计算机断层扫描血管造影评估移植血管通畅情况。根据远端吻合口闭塞数量将患者分为2组:I组无至1处闭塞(n = 209),II组有2至4处闭塞(n = 24)。

结果

233例患者在术后平均7.5(1 - 18)年接受了计算机断层扫描血管造影。模型调整后,II组和I组之间EQ-视觉模拟量表和EQ-5D指数的平均差异分别为-19.8(95%可信区间-25.3至-14.3;P < 0.001)和-0.13(95%可信区间-0.19至-0.08;P < 0.001)。研究人群的EQ-5D指数与瑞典人群相似,分别为0.851和0.832,效应大小为0.112(微不足道)。研究人群的EQ-5D指数高于瑞典人群中的缺血性心脏病组,分别为0.851和0.60,效应大小为0.999(大)。

结论

冠状动脉搭桥患者的移植血管通畅情况与更高的健康相关生活质量相关。与瑞典普通人群相比,该患者群体报告的功能和幸福感相似,且健康状况优于普通人群中同一疾病组的患者。

临床注册号

Clinicaltrials.gov:NCT02547194以及瑞典研发注册:167861。

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