Bouabdallaoui Nadia, Stevens Susanna R, Doenst Torsten, Wrobel Krzysztof, Bouchard Denis, Deja Marek A, Michler Robert E, Chua Yeow Leng, Kalil Renato A K, Selzman Craig H, Daly Richard C, Sun Benjamin, Djokovic Ljubomir T, Sopko George, Velazquez Eric J, Rouleau Jean L, Lee Kerry L, Al-Khalidi Hussein R
Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
J Cardiothorac Vasc Anesth. 2018 Jun;32(3):1256-1263. doi: 10.1053/j.jvca.2017.12.038. Epub 2017 Dec 23.
The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients.
DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time.
At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of intubation time >36 hours included mitral valve procedure, New York Heart Association class, left ventricular systolic volume index, creatinine, previous coronary artery bypass grafting (CABG), and age. Results were similar in patients surviving 24 hours post-operation, where intubation time was also the strongest predictor of 30-day (HR 4.18, c-index 0.87) and 1-year (HR 2.81, c-index 0.78) mortality.
Intubation time is the strongest predictor of 30-day and 1-year mortality among patients with ischemic heart failure undergoing CABG. Combining intubation time with other mortality risk factors may allow the identification of patients at the highest risk for whom the development of specific strategies may improve outcomes.
作者旨在评估缺血性心力衰竭外科治疗（STICH）试验患者插管时间的决定因素，并评估其对术后30天和1年生存率的影响。
设计、设置、参与者和干预措施：对STICH试验中术后存活36小时的1446例手术患者采用多变量Cox比例风险模型，以确定与术后30天和1年死亡率相关的围手术期因素。采用多变量逻辑回归模型确定与插管时间相关的危险因素。
术后36小时，1446例中有1298例（89.8%）拔管，148例（10.2%）仍插管。术后插管时间中位数为11.4小时。在术后存活36小时的患者中，建立了一个多变量模型来预测30天（c指数=0.88）和1年（c指数=0.78）死亡率。插管时间是30天（风险比[HR]5.50）和1年死亡率（HR 3.69）最强的独立预测因素。插管时间>36小时的预测因素包括二尖瓣手术、纽约心脏协会分级、左心室收缩容积指数、肌酐、既往冠状动脉搭桥术（CABG）和年龄。术后存活24小时的患者结果相似，插管时间也是30天（HR 4.18，c指数0.87）和1年（HR 2.81，c指数0.78）死亡率最强的预测因素。
在接受冠状动脉搭桥术的缺血性心力衰竭患者中，插管时间是30天和1年死亡率最强的预测因素。将插管时间与其他死亡风险因素相结合，可能有助于识别出风险最高的患者，针对这些患者制定特定策略可能会改善预后。
