Norwich Medical School, University of East Anglia, Norwich, UK.
Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK.
Eur J Cardiothorac Surg. 2022 May 27;61(6):1414-1420. doi: 10.1093/ejcts/ezac043.
The objective of this investigation was to determine the preoperative prognostic factors of long-term (10-year) mortality in patients treated with isolated coronary artery bypass graft surgery in the arterial revascularization trial (ART).
A post hoc analysis of the ART was conducted. Cumulative 10-year mortality was estimated using the Kaplan-Meier method. Prospectively collected preoperative data were used to determine the prognostic factors of 10-year all-cause mortality in patients who participated in the ART (Cox proportional hazards model).
A total of 3102 patients who participated in the ART were included in the analysis. Ten-year follow-up was completed in 3040 patients (98%). A total of 644 patients (20.8%) had died by 10 years. Preoperative factors that were identified as statistically significant predictors of 10-year mortality in the multivariable analysis (all P ≤ 0.01) were: left ventricular ejection fraction, atrial fibrillation, age, diabetes, prior cerebrovascular event (stroke or transient ischaemic attack), serum creatinine and smoking status. The following variables were significantly associated in univariable models but did not retain significance in the multivariable model for mortality: non-Caucasian ethnicity, hypertension, peripheral vascular disease, chronic obstructive pulmonary disease and prior myocardial infarction.
Independent predictors of 10-year mortality in the ART were multifactorial. Several key independent predictors of 10-year mortality in the ART were identified including: heart function, renal function, cerebrovascular disease, age, atrial fibrillation, smoking status and diabetes. Understanding which preoperative variables influence long-term outcome after coronary artery bypass grafting may help to target treatments to those at higher risk to reduce mortality.
本研究旨在确定动脉血管重建试验（ART）中接受单纯冠状动脉旁路移植术治疗的患者的长期（10 年）死亡率的术前预测因素。
对 ART 进行了事后分析。采用 Kaplan-Meier 法估计 10 年累积死亡率。使用 ART 参与者前瞻性收集的术前数据，通过 Cox 比例风险模型确定 10 年全因死亡率的预后因素。
共纳入 3102 例参与 ART 的患者进行分析。3040 例（98%）患者完成了 10 年随访。共有 644 例患者（20.8%）在 10 年内死亡。多变量分析中，术前因素被确定为 10 年死亡率的统计学显著预测因素（均 P≤0.01），包括：左心室射血分数、心房颤动、年龄、糖尿病、既往脑血管事件（中风或短暂性脑缺血发作）、血清肌酐和吸烟状况。在单变量模型中显著相关但在多变量死亡率模型中没有保留意义的变量有：非白种人、高血压、外周血管疾病、慢性阻塞性肺疾病和既往心肌梗死。
ART 中 10 年死亡率的独立预测因素是多因素的。确定了 ART 中 10 年死亡率的几个关键独立预测因素，包括：心功能、肾功能、脑血管疾病、年龄、心房颤动、吸烟状况和糖尿病。了解哪些术前变量会影响冠状动脉旁路移植术后的长期结果，可能有助于针对高危患者进行治疗，以降低死亡率。
