Pang Philip Y K, Teow Christopher K J, Huang Ming Jie, Naik Madhava J, Lim See Lim, Chao Victor T T, Tan Teing Ee, Chua Yeow Leng, Sin Yoong Kong
Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore.
Ministry of Health Holdings, Singapore.
J Thorac Dis. 2020 Nov;12(11):6722-6730. doi: 10.21037/jtd-20-2046.
Cardiovascular disease is a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Coronary artery bypass grafting (CABG) is beneficial in selected patients with ESRD. This study investigates the survival outcomes and prognostic factors in ESRD patients who underwent CABG.
A retrospective analysis was performed for 149 patients with ESRD who underwent isolated CABG between 2006 and 2015.
Mean age was 59.4±8.7 years and 106 patients (71.1%) were male. Operative mortality occurred in 20 patients (13.4%). Overall survival was 81.1%±3.2% at 1 year, 41.5%±4.3% at 5 years and 19.2%±4.2% at 10 years. Median survival was 4.3 years. Multivariable analysis identified age [P=0.001, odds ratio (OR): 1.15 per 1-year increase, 95% confidence interval (CI): 1.06-1.25], preoperative left ventricular ejection fraction (LVEF) (P=0.020, OR: 0.94, 95% CI: 0.89-0.99) and non-elective status of operation (P=0.049, OR: 3.34, 95% CI: 1.00-11.1) as predictors of operative mortality. Cox regression analysis identified age [P<0.001, hazard ratio (HR): 1.05 per 1-year increase, 95% CI: 1.03-1.08], New York Heart Association (NYHA) class III or IV status (P=0.010, HR: 1.75, 95% CI: 1.15-2.67) and the use of a left internal mammary artery (LIMA) to left anterior descending artery (LIMA-LAD) graft (P=0.029, HR: 0.42, 95% CI: 0.19-0.92) as factors influencing long-term survival.
CABG is associated with high operative mortality and poor long-term survival in ESRD patients. Age and NYHA class influenced late survival. LIMA-LAD grafting conferred a long-term survival advantage.
心血管疾病是终末期肾病（ESRD）患者发病和死亡的主要原因。冠状动脉旁路移植术（CABG）对部分ESRD患者有益。本研究调查了接受CABG的ESRD患者的生存结局和预后因素。
对2006年至2015年间接受单纯CABG的149例ESRD患者进行回顾性分析。
平均年龄为59.4±8.7岁，106例患者（71.1%）为男性。20例患者（13.4%）发生手术死亡。1年总生存率为81.1%±3.2%，5年为41.5%±4.3%，10年为19.2%±4.2%。中位生存期为4.3年。多变量分析确定年龄[P=0.001，比值比（OR）：每增加1岁为1.15，95%置信区间（CI）：1.06-1.25]、术前左心室射血分数（LVEF）（P=0.020，OR：0.94，95%CI：0.89-0.99）和手术的非择期状态（P=0.049，OR：3.34，95%CI：1.00-11.1）为手术死亡的预测因素。Cox回归分析确定年龄[P<0.001，风险比（HR）：每增加1岁为1.05，95%CI：1.03-1.08]、纽约心脏协会（NYHA）III或IV级状态（P=0.010，HR：1.75，95%CI：1.15-2.67）以及使用左乳内动脉（LIMA）至左前降支动脉（LIMA-LAD）移植（P=0.029，HR：0.42，95%CI：0.19-0.92）为影响长期生存的因素。
CABG与ESRD患者的高手术死亡率和较差的长期生存率相关。年龄和NYHA分级影响晚期生存。LIMA-LAD移植具有长期生存优势。
