Peterson E D, Jollis J G, Bebchuk J D, DeLong E R, Muhlbaier L H, Mark D B, Pryor D B
Department of Medicine, Duke University Medical Center, Durham, NC 27710-7510.
Ann Intern Med. 1994 Dec 15;121(12):919-27. doi: 10.7326/0003-4819-121-12-199412150-00003.
To examine secular changes in the use and outcome of percutaneous transluminal coronary angioplasty and cardiac bypass graft surgery in the elderly.
A retrospective cohort study based on a longitudinal database created from the administrative files of Medicare.
U.S. hospitals that perform myocardial revascularization procedures covered by Medicare.
225,915 consecutive patients who had angioplasty and 357,885 consecutive patients who had bypass surgery from 1987 to 1990.
The rates of angioplasty and bypass surgery use; unadjusted 30-day and 1-year mortality rates after revascularization; and adjusted odds ratios for mortality by year of procedure for 1987 to 1990.
From 1987 to 1990, the rates of angioplasty and bypass surgery done in the elderly increased by 55% and 18%, respectively. During this period, 30-day unadjusted mortality rates after angioplasty and bypass surgery decreased by 25% (95% CI, 22% to 28%) and 12% (CI, 10% to 14%), and 1-year mortality rates decreased by 10% (CI, 8% to 11%) and 8% (CI, 7% to 10%), respectively. After adjustment for changes in patient characteristics, 30-day mortality rates after these procedures decreased by 37% (CI, 32% to 41%) and 18% (CI, 14% to 21%), and 1-year mortality rates decreased by 22% (CI, 18% to 25%) and 19% (CI, 16% to 21%), respectively.
The use of cardiac revascularization procedures in the elderly has steadily increased. Patients who had revascularization are progressively older, have more coded comorbid conditions, and present with more acute diseases. Although elderly patients have apparently higher risk profiles, mortality rates after angioplasty and bypass surgery in the elderly have decreased, suggesting a national improvement in the outcomes of these interventions. Health policy decisions concerning revascularization procedures in the elderly must consider these trends in improved outcome.
研究老年人经皮腔内冠状动脉成形术及心脏搭桥手术的应用情况及疗效的长期变化。
基于医疗保险行政档案建立的纵向数据库进行的回顾性队列研究。
实施医疗保险覆盖的心肌血运重建手术的美国医院。
1987年至1990年间连续接受血管成形术的225,915例患者及连续接受搭桥手术的357,885例患者。
血管成形术及搭桥手术的应用率；血运重建术后未经调整的30天及1年死亡率；1987年至1990年各手术年份死亡率的调整比值比。
1987年至1990年，老年人血管成形术及搭桥手术的应用率分别上升了55%和18%。在此期间，血管成形术及搭桥手术后未经调整的30天死亡率分别下降了25%（95%可信区间，22%至28%）和12%（可信区间，10%至14%），1年死亡率分别下降了10%（可信区间，8%至11%）和8%（可信区间，7%至10%）。在对患者特征变化进行调整后，这些手术的30天死亡率分别下降了37%（可信区间，32%至41%）和18%（可信区间，14%至21%），1年死亡率分别下降了22%（可信区间，18%至25%）和19%（可信区间，16%至21%）。
老年人心脏血运重建手术的应用稳步增加。接受血运重建的患者年龄越来越大，合并症编码更多，急性疾病更多。尽管老年患者的风险状况明显更高，但老年人血管成形术及搭桥手术后的死亡率有所下降，表明这些干预措施的疗效在全国范围内有所改善。关于老年人血运重建手术的卫生政策决策必须考虑这些疗效改善的趋势。
