Ruttmann Elfriede, Abfalterer Hannes, Dietl Marion, Wagner Julian, Kilo Juliane, Grimm Michael, Bates Katie, Fritz Josef, Ulmer Hanno
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
Department of Plastic and Reconstructive Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
Eur J Cardiothorac Surg. 2020 May 1;57(5):986-993. doi: 10.1093/ejcts/ezz333.
Parental cardiovascular disease (CVD) is a known risk factor for premature CVD. It is unknown whether a positive family history (PFH) affects outcomes after coronary artery bypass grafting (CABG).
Data come from a retrospective longitudinal study of CABG patients consecutively recruited from 2001 to 2018 (n = 5389). From this study, 2535 patients with premature CVD undergoing CABG under the age of 60 years and information on parental CVD were identified. The Framingham offspring study criteria were used to identify PFH of CVD. Multivariable Cox proportional hazards regression models were used to assess the effect of PFH on overall and major adverse cardiovascular and cerebrovascular event-free survival.
A total of 273 deaths and 428 major adverse cardiovascular and cerebrovascular events occurred during follow-up. PFH of CVD was found in 54.2% of patients (n = 1375). Within these patients, 66.1% had a father who experienced a premature cardiovascular event (n = 909), 27.8% a mother (n = 382) and 6.1% both a mother and a father (n = 84). In the majority of cases, the patient's parent had experienced a cardiac event (85.9%, n = 1181) and 14.1% of patients with PFH reported parental stroke (n = 194). Following CABG, PFH was associated with improved overall [adjusted hazards ratio (HR) 0.67, 95% confidence interval (CI) 0.50-0.90; P = 0.008] and major adverse cardiovascular and cerebrovascular event-free survival (adjusted HR 0.73, 95% CI 0.68-0.89; P = 0.01). Among the covariates adjusted for age, diabetes, renal insufficiency, peripheral arterial disease, ejection fraction, previous cerebrovascular events and previous mediastinal radiation were all associated with poorer outcomes.
Although it is well established that a PFH increases the risk of requiring CABG at younger ages, this study shows that, paradoxically, PFH is also protective regarding long-term outcomes.
UN4232 297/4.3 (retrospective study).
父母患心血管疾病（CVD）是已知的早发性CVD风险因素。家族史阳性（PFH）是否会影响冠状动脉旁路移植术（CABG）后的预后尚不清楚。
数据来自于一项对2001年至2018年连续招募的CABG患者的回顾性纵向研究（n = 5389）。在这项研究中，确定了2535例60岁以下接受CABG的早发性CVD患者以及父母CVD的信息。采用弗雷明汉后代研究标准来确定CVD的PFH。使用多变量Cox比例风险回归模型来评估PFH对总体及主要不良心血管和脑血管无事件生存率的影响。
随访期间共发生273例死亡和428例主要不良心血管和脑血管事件。54.2%的患者（n = 1375）存在CVD的PFH。在这些患者中，66.1%的患者父亲有早发性心血管事件（n = 909），27.8%的患者母亲有（n = 382），6.1%的患者父母均有（n = 84）。在大多数情况下，患者的父母发生过心脏事件（85.9%，n = 1181），14.1%有PFH的患者报告父母有中风（n = 194）。CABG后，PFH与总体生存率改善相关[调整后风险比（HR）0.67，95%置信区间（CI）0.50 - 0.90；P = 0.008]以及主要不良心血管和脑血管无事件生存率相关（调整后HR 0.73，95% CI 0.68 - 0.89；P = 0.01）。在调整的协变量中，年龄、糖尿病、肾功能不全、外周动脉疾病、射血分数、既往脑血管事件和既往纵隔放疗均与较差的预后相关。
虽然公认PFH会增加年轻时需要进行CABG的风险，但这项研究表明，矛盾的是，PFH在长期预后方面也具有保护作用。
注册号 当地机构审查委员会：UN4232 297/4.3（回顾性研究）
