Northport VA Medical Center, Northport, NY; Duke University Medical Center, Durham, NC.
Eastern Colorado Health Care System, Denver VA Medical Center, Denver, CO; University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
Am Heart J. 2018 Apr;198:33-38. doi: 10.1016/j.ahj.2017.12.014. Epub 2017 Dec 24.
For advanced coronary disease, coronary artery bypass graft (CABG) surgery generally improves patients' symptoms and long-term survival. Unfortunately, some patients experience worse health-related quality of life (HRQL) after CABG. The objective of this study is to report the frequency and risk factors associated with 1-year post-CABG HRQL deterioration.
From 2002 to 2007, 2203 "Randomized On/Off Bypass" (ROOBY) trial patients randomly received either off-pump or on-pump CABG at 18 VA medical centers. Subjects completed both baseline and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR-36) questionnaires to assess HRQL. Using previously published criteria, the rates of clinically significant changes were determined for the SAQ [angina frequency (AF), physical limitation (PL), and quality of life (QoL)] and VR36 [mental component score (MCS) and physical component score (PCS)] subscales. Multivariate regression models were then used to identify pre-CABG patient characteristics associated with worsened 1-year HRQL status for each subscale.
Over 80% of patients had an improvement or no change in SAQ and VR-36 subscale scores 1 year after CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8% SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of 1-year HRQL deterioration were diabetes and smoking for the SAQ-AF; diabetes, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL; diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS. The baseline score was an independent predictor for worsening in all the subscales studied.
Among VA patients, less than 20% experienced worse HRQL 1 year after CABG. For patients with low symptom burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior stroke, clinicians should be more cautious in pre-CABG counseling as to their anticipated HRQL improvements.
对于晚期冠心病，冠状动脉旁路移植术（CABG）通常可以改善患者的症状和长期生存率。不幸的是，一些患者在 CABG 后健康相关生活质量（HRQL）恶化。本研究的目的是报告 1 年后 CABG 后 HRQL 恶化的频率和相关危险因素。
2002 年至 2007 年，2203 名“随机开/关旁路”（ROOBY）试验患者在 18 家退伍军人事务部医疗中心随机接受非体外循环或体外循环 CABG。受试者在基线和 1 年时完成西雅图心绞痛问卷（SAQ）和退伍军人兰德 36 项（VR-36）问卷，以评估 HRQL。使用先前发表的标准，确定 SAQ[心绞痛频率（AF）、体力限制（PL）和生活质量（QoL）]和 VR36[心理成分评分（MCS）和生理成分评分（PCS）]子量表的临床显著变化率。然后使用多变量回归模型来确定每个子量表中与 CABG 后 1 年 HRQL 状态恶化相关的术前患者特征。
超过 80%的患者在 CABG 后 1 年时 SAQ 和 VR-36 子量表评分有改善或无变化。HRQL 量表特定恶化率为 4.5%SAQ-AF、16.8%SAQ-PL、4.9%SAQ-QoL、19.4%VR36-MCS 和 13.5%VR36-PCS。SAQ-AF 的 1 年 HRQL 恶化预测因素为糖尿病和吸烟；SAQ-PL 为糖尿病、慢性阻塞性肺疾病（COPD）和外周血管疾病（PVD）；SAQ-QoL 为 COPD 和抑郁；VR36-PCS 为糖尿病，VR36-MCS 为中风史和抑郁。基线评分是所有研究子量表恶化的独立预测因子。
在退伍军人事务部患者中，不到 20%的患者在 CABG 后 HRQL 恶化。对于基线症状负担较低的患者，糖尿病、吸烟、抑郁、PVD、COPD 和既往卒中，临床医生应在 CABG 前咨询中更加谨慎地预测其预期的 HRQL 改善。
