Hua K, Sheng J J, Dong R
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2017 Apr 25;97(16):1218-1221. doi: 10.3760/cma.j.issn.0376-2491.2017.16.007.
To explore short-term clinical outcomes and risk factors associated with in-hospital mortality in patients undergoing off-pump coronary artery bypass grafting (OPCABG) and establish a prediction model for in-hospital mortality. The clinical data of patients undergoing OPCABG in Beijing Anzhen Hospital between January 2014 and January 2016 was retrospectively studied. Univariate analysis and logistic regression were applied to determine the potential risk factors, and then a prediction model for mortality was confirmed. The calibration and discrimination of the prediction model was finally tested. A total of 2 546 patients who underwent OPCABG were recruited. In-hospital mortality of OPCABG was 0.7% (17 cases). Seven variables: female, age, left main disease >50%, low left ventricular ejection fraction (LVEF), acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation were independently correlated with OPCABG mortality (all <0.05). The result of Hosmer-Lemeshow test was χ(2)=5.912, =0.676. The area under receiver-operating characteristic curve (ROC) was 0.881. OPCABG is safe and effective for myocardial revascularization in a short term. The following risk factors are associated with an increased operative mortality of OPCABG: male, age, left main disease >50%, low LVEF, acute myocardial infarction before surgery, operative status (selective or emergent), moderate concomitant mitral valve regurgitation. The prediction model established by above-mentioned potential risk factors was proven to perform well by statistical tests.
探讨非体外循环冠状动脉搭桥术(OPCABG)患者的短期临床结局及与院内死亡相关的危险因素,并建立院内死亡预测模型。回顾性研究2014年1月至2016年1月在北京安贞医院行OPCABG患者的临床资料。采用单因素分析和logistic回归确定潜在危险因素,进而确定死亡预测模型。最后对预测模型的校准和区分度进行检验。共纳入2546例行OPCABG的患者。OPCABG的院内死亡率为0.7%(17例)。七个变量:女性、年龄、左主干病变>50%、左心室射血分数(LVEF)低、术前急性心肌梗死、手术状态(选择性或急诊)、中度合并二尖瓣反流与OPCABG死亡率独立相关(均<0.05)。Hosmer-Lemeshow检验结果为χ(2)=5.912,P=0.676。受试者工作特征曲线(ROC)下面积为0.881。OPCABG在短期内对心肌血运重建是安全有效的。以下危险因素与OPCABG手术死亡率增加相关:男性、年龄、左主干病变>50%、LVEF低、术前急性心肌梗死、手术状态(选择性或急诊)、中度合并二尖瓣反流。经统计检验证明,由上述潜在危险因素建立的预测模型性能良好。