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围手术期阿司匹林与冠状动脉旁路移植术后患者的长期生存

Perioperative aspirin and long-term survival in patients undergoing coronary artery bypass graft.

机构信息

Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, 19107, USA.

Anesthesiology and Critical Care, Tangdu Hospital, The Fourth Military Medical University, Xian, 710038, P. R. China.

出版信息

Sci Rep. 2018 Nov 19;8(1):17051. doi: 10.1038/s41598-018-35208-7.

Abstract

This study aimed to examine association between perioperative uses of aspirin and long-term survival in patients undergoing CABG. A retrospective cohort study was performed in 9,584 consecutive patients receiving cardiac surgery from three tertiary hospitals. Of all the patients, 4,132 patients undergoing CABG met inclusion criteria and were divided into four groups: with or without preoperative or postoperative aspirin respectively. 30-day postoperative and long-term mortality were compared with the use of propensity scores and inverse probability weighting adjustment to reduce the treatment-selection bias. The patients taking preoperative aspirin presented significantly more with comorbidities. However, the results of this study showed that preoperative aspirin (vs. no preoperative aspirin) was associated with significantly reduced the risk of 30-day mortality in the patients undergoing CABG. Further, the results of long-term mortality showed that the patients taking preoperative aspirin and postoperative aspirin (vs. not taking) were associated with significantly reduced the risk of 4-year mortality (14.8% vs. 18.1%, RR: 0.82, 95% CI: 0.75-0.89, P = 0.005; 10.7% vs. 16.2%, RR: 0.66, 95% CI: 0.50-0.82, P = 0.003). In conclusion, this cohort study showed that perioperative (before and after surgery) use of aspirin was associated with significant reduction in 30-day mortality without significant bleeding complications, also improved long-term survival in patients undergoing CABG.

摘要

本研究旨在探讨阿司匹林在 CABG 患者围手术期的使用与长期生存之间的关系。对三家三级医院心脏手术的 9584 例连续患者进行了回顾性队列研究。在所有患者中,4132 例行 CABG 的患者符合纳入标准,并分为四组:分别有无术前或术后阿司匹林。采用倾向评分和逆概率加权调整来比较术后 30 天和长期死亡率,以减少治疗选择偏倚。服用术前阿司匹林的患者合并症明显更多。然而,本研究结果表明,与不服用术前阿司匹林相比,术前服用阿司匹林(vs. 不服用术前阿司匹林)可显著降低 CABG 患者 30 天死亡率的风险。此外,长期死亡率的结果表明,术前和术后服用阿司匹林(vs. 不服用)的患者与 4 年死亡率的降低显著相关(14.8% vs. 18.1%,RR:0.82,95%CI:0.75-0.89,P=0.005;10.7% vs. 16.2%,RR:0.66,95%CI:0.50-0.82,P=0.003)。总之,这项队列研究表明,围手术期(术前和术后)使用阿司匹林可显著降低 30 天死亡率,且无明显出血并发症,也可改善 CABG 患者的长期生存。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/047f/6242822/d4751e57d0fa/41598_2018_35208_Fig1_HTML.jpg

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