Georges Daniela, Kreft Daniel, Doblhammer Gabriele
Department of Sociology and Demography, University of Rostock, Rostock, Germany.
German Centre for Neurodegenerative Diseases, Bonn, Germany.
J Thorac Dis. 2024 Aug 31;16(8):4863-4874. doi: 10.21037/jtd-24-251. Epub 2024 Aug 16.
Coronary artery bypass grafting (CABG) and drug-eluting stent implantation (DES) are established as central methods of revascularization for patients with coronary artery disease. This study aims to analyse the health trajectories of patients after first CABG or first, second or third DES within the first three years, with a focus on follow-up interventions, severe care need, transition into a nursing home, and death.
Based on health claims data (n=11,581), we estimated age-and sex standardized probabilities of reintervention, and of transition to severe care need, nursing home and death following initial CABG (n=2,008) or DES (n=9,573) for patients aged 50 years and older using logistic regression models and direct standardization. Up to three follow-up DES interventions and one follow-up CABG were considered.
There was a fairly high probability of reintervention, particularly after a DES and within the first year. Follow-up interventions were more likely to involve DES than CABG. The probability of death was notably higher for CABG patients. The probabilities of severe care need and moving to a nursing home were slightly lower and similar across the revascularization methods and over time.
DES and CABG are often associated with a need for follow-up interventions. Depending on the procedure, however, the risk of repeat surgery or adverse health outcomes varies. DES is associated with a relatively high probability of follow-up revascularization and a nearly constant probability of negative health outcomes in the short and medium term. In contrast, within three years after a CABG, follow-up reinterventions are rather rare. However, this procedure is particularly associated with an increased risk of mortality and short-term transition into a nursing home.
冠状动脉旁路移植术（CABG）和药物洗脱支架植入术（DES）已成为冠心病患者血运重建的主要方法。本研究旨在分析首次接受CABG或首次、第二次或第三次DES治疗的患者在头三年内的健康轨迹，重点关注随访干预、重症护理需求、转入养老院以及死亡情况。
基于健康保险数据（n = 11,581），我们使用逻辑回归模型和直接标准化方法，估计了50岁及以上患者在首次接受CABG（n = 2,008）或DES（n = 9,573）后再次干预、转为需要重症护理、入住养老院和死亡的年龄和性别标准化概率。考虑了多达三次随访DES干预和一次随访CABG。
再次干预的可能性相当高，尤其是在DES治疗后且在第一年内。随访干预更有可能涉及DES而非CABG。CABG患者的死亡概率明显更高。重症护理需求和入住养老院的概率略低，且在不同血运重建方法和不同时间内相似。
DES和CABG通常都需要进行随访干预。然而，根据手术方式不同，再次手术或不良健康结局的风险也有所不同。DES与随访血运重建的相对高概率以及短期和中期负面健康结局的近乎恒定概率相关。相比之下，CABG术后三年内随访再次干预相当罕见。然而，该手术特别与死亡率增加和短期内转入养老院的风险相关。
