He G W, Acuff T E, Ryan W H, Mack M J
Cardiothoracic Surgery Associates of North Texas at Medical City Dallas Hospital.
Ann Thorac Surg. 1994 Jun;57(6):1453-60; discussion 1460-1. doi: 10.1016/0003-4975(94)90100-7.
From January 1986 through June 1992, 512 elderly patients (70 years and older) underwent internal mammary artery grafting (IMAG). The operative mortality in these patients was 7.62% (39 of 512), which was significantly higher than that (1.97% [60 of 3,047]; p < 0.0001) in younger patients (under 70 years old). To investigate the risk factors in the elderly, the data from the 512 patients were evaluated by univariate analysis and multiple logistic regression. Of 53 variables analyzed, nine preoperative variables (age, smoking history, congestive heart failure, myocardial infarction, New York Heart Association functional class, ejection fraction, left main artery disease, stenosis of the left anterior descending artery, and reoperation), three intraoperative variables (emergency operation, bilateral IMAG, and right IMAG), and nine postoperative variables were significantly associated with the higher mortality (p < 0.05). In particular, the operative mortality was significantly higher in the patients undergoing right IMAG (21.62% [8 of 37]) than that in patients only undergoing left IMAG (6.53% [31 of 475]; p < 0.004). The significant preoperative and intraoperative variables and the variables that have a tendency for correlation (p < 0.2) to mortality were included in a stepwise multiple logistic regression. The regression analysis demonstrated that right IMAG, reoperation, history of myocardial infarction, age, left main artery disease, history of smoking, and postoperative complications are the risk factors for the elderly undergoing IMAG. Therefore, particular care should be taken in those patients scheduled to undergo IMAG. The role of right IMAG in the elderly should be further clarified before universal acceptance of the technique in these patients.
1986年1月至1992年6月，512例老年患者（70岁及以上）接受了乳内动脉移植术（IMAG）。这些患者的手术死亡率为7.62%（512例中的39例），显著高于年轻患者（70岁以下）的手术死亡率（1.97%[3047例中的60例]；p<0.0001）。为了研究老年患者的危险因素，对512例患者的数据进行了单因素分析和多因素逻辑回归分析。在分析的53个变量中，9个术前变量（年龄、吸烟史、充血性心力衰竭、心肌梗死、纽约心脏协会功能分级、射血分数、左主干病变、左前降支狭窄和再次手术）、3个术中变量（急诊手术、双侧IMAG和右侧IMAG）以及9个术后变量与较高的死亡率显著相关（p<0.05）。特别是，接受右侧IMAG的患者手术死亡率（21.62%[37例中的8例]）显著高于仅接受左侧IMAG的患者（6.53%[475例中的31例]；p<0.004）。将显著的术前和术中变量以及与死亡率有相关趋势（p<0.2）的变量纳入逐步多因素逻辑回归分析。回归分析表明，右侧IMAG、再次手术、心肌梗死病史、年龄、左主干病变、吸烟史和术后并发症是老年患者接受IMAG的危险因素。因此，对于计划接受IMAG的患者应格外小心。在这些患者中普遍接受该技术之前，应进一步明确右侧IMAG在老年患者中的作用。
