Cardiothoracic Surgery, Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
Cardiothoracic Surgery Department of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1839-1844. doi: 10.1111/ans.17817. Epub 2022 Jun 10.
Aboriginal and Torres Strait Islander (Indigenous) Australians have an increased prevalence of coronary artery disease and present at a younger age for coronary artery bypass graft surgery (CABG) when compared to non-Indigenous Australians. Studies have reported postoperative outcomes in Indigenous people to be less favourable. Therefore, the aim of this study is to evaluate long term mortality between Indigenous and non-Indigenous people post-CABG.
We analysed data on all patients who underwent isolated CABG, with and without cardiopulmonary bypass, at our institution between January 1998 to September 2008. There were 33 395 person-years of survival for analysis with a median follow-up of 13 years (Interquartile range (IQR): 8-16 years). We analysed all-cause mortality with the Kaplan-Meier graph and log-rank test. Univariate and multivariate analysis was performed using a Cox proportional hazards model.
The mean age at presentation for Indigenous people was 52 years compared to 65 yr for non-indigenous people. There were 1431 (52.1%) deaths by the study census date, with the overall mortality for Indigenous patients at 49.8% (n = 147) and 52.4% for non-Aboriginal patients (n = 1284). The age and comorbidities adjusted hazard ratio (HR) for all-cause late mortality (median years) was HR = 1.712 (95% CI: 1.288-2.277, p < 0.001).
Indigenous patients present for CABG at a younger age and have a higher prevalence of comorbidities. Our study demonstrates they have a higher risk of propensity adjusted all-cause long term mortality. Primary and secondary prevention strategies, tailored to Indigenous people, may improve health outcomes in the long-term post-CABG.
与非原住民澳大利亚人相比，澳大利亚原住民和托雷斯海峡岛民（土著）的冠心病患病率更高，并且在更年轻时就需要进行冠状动脉旁路移植术（CABG）。研究报告称，土著人的术后结果不太理想。因此，本研究旨在评估 CABG 后土著人和非土著人之间的长期死亡率。
我们分析了在我们机构接受单纯 CABG 治疗的患者（包括体外循环和非体外循环）的所有患者的数据，这些患者的治疗时间为 1998 年 1 月至 2008 年 9 月。在 33,395 人年的生存分析中，中位随访时间为 13 年（四分位距（IQR）：8-16 年）。我们使用 Kaplan-Meier 图和对数秩检验分析全因死亡率。使用 Cox 比例风险模型进行单变量和多变量分析。
土著人就诊时的平均年龄为 52 岁，而非土著人就诊时的平均年龄为 65 岁。在研究截止日期时，共有 1431 人（52.1%）死亡，土著患者的总死亡率为 49.8%（n=147），非原住民患者的死亡率为 52.4%（n=1284）。年龄和合并症调整后的全因晚期死亡率（中位年数）的风险比（HR）为 1.712（95%置信区间：1.288-2.277，p<0.001）。
土著患者接受 CABG 的年龄更小，合并症的患病率更高。我们的研究表明，他们有更高的倾向性调整后全因长期死亡率的风险。针对土著人的一级和二级预防策略可能会改善 CABG 后长期的健康结果。
