Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH.
Division of Cardiology, National Heart, Lung and Blood Institute, Bethesda, MD.
Mayo Clin Proc. 2020 Sep;95(9):1865-1876. doi: 10.1016/j.mayocp.2020.05.044.
To characterize the contemporary efficacy and utilization patterns of coronary artery bypass grafting (CABG) in specific cancer types.
We leveraged the data from the National Inpatient Sample and plotted trends of utilization and outcomes of isolated CABG (with no other additional surgeries during the same hospitalization) procedures from January 1, 2003, through September 1, 2015. Propensity score matching was used to assess for potential differences in outcomes by type of cancer status among contemporary (2012-2015) patients.
Overall, the utilization of CABG decreased over time (250,677 in 2003 vs 134,534 in 2015, P<.001). However, the proportion of those with comorbid cancer increased (7.0% vs 12.6%, P<.001). Over time, in-hospital mortality associated with CABG use in cancer remained unchanged (.9% vs 1.0%, P=.72); yet, cancer patients saw an increase in associated major bleeding (4.5% vs 15.3%, P<.001) and rate of stroke (.9% vs 1.5%, P<.001) over time. In-hospital cost-of-care associated with CABG-use in cancer also increased over time ($29,963 vs $33,636, P<.001). When stratified by cancer types, in-hospital mortality was not higher in breast, lung, prostate, colon cancer, or lymphoma versus non-cancer CABG patients (all P>.05). However, there was a significantly higher prevalence of major bleeding but not stroke in patients with breast and prostate cancer only compared with non-cancer CABG patients (P<.01). Discharge dispositions were not found to be different between cancer sub-groups and non-cancer patients (P>.05), except for breast cancer patients who had lower home care, but higher skilled care disposition (P<.001).
Among those undergoing CABG, the prevalence of comorbid cancer has steadily increased. Outside of major bleeding, these patients appear to share similar outcomes to those without cancer indicating that CABG utilization should be not be declined in cancer patients when otherwise indicated. Further research into the factors underlying the decision to pursue CABG in specific cancer sub-groups is needed.
描述特定癌症类型中冠状动脉旁路移植术（CABG）的当代疗效和利用模式。
我们利用国家住院患者样本中的数据，绘制了 2003 年 1 月 1 日至 2015 年 9 月 1 日期间，单独进行 CABG（同一住院期间无其他附加手术）手术的利用和结果趋势。采用倾向评分匹配评估当代（2012-2015 年）患者中不同癌症状态类型的潜在结果差异。
总体而言，CABG 的使用率随时间推移而下降（2003 年为 250677 例，2015 年为 134534 例，P<.001）。然而，合并癌症的比例增加（7.0%对 12.6%，P<.001）。随着时间的推移，癌症患者 CABG 使用率相关的院内死亡率保持不变（0.9%对 1.0%，P=.72）；然而，癌症患者的主要出血（4.5%对 15.3%，P<.001）和中风发生率（0.9%对 1.5%，P<.001）呈上升趋势。与癌症患者 CABG 使用率相关的院内治疗费用也随时间推移而增加（29963 美元对 33636 美元，P<.001）。按癌症类型分层，乳腺癌、肺癌、前列腺癌、结肠癌或淋巴瘤患者与非癌症 CABG 患者相比，院内死亡率并不更高（均 P>.05）。然而，与非癌症 CABG 患者相比，仅乳腺癌和前列腺癌患者的主要出血发生率更高，但中风发生率无差异（P<.01）。除乳腺癌患者的家庭护理减少，但熟练护理处置增加（P<.001）外，癌症亚组患者与非癌症患者的出院处置方式无差异（P>.05）。
在接受 CABG 的患者中，合并癌症的患病率稳步上升。除了大出血之外，这些患者的结果与无癌症患者相似，这表明在其他方面有指征时，不应拒绝癌症患者进行 CABG。需要进一步研究决定在特定癌症亚组中进行 CABG 的决策背后的因素。
