Christenson J T, Schmuziger M, Maurice J, Simonet F, Velebit V
Cardiovascular Unit, Hôpital de la Tour, Geneva, Switzerland.
Coron Artery Dis. 1994 Feb;5(2):169-74. doi: 10.1097/00019501-199402000-00011.
Data from patients younger than 75 years (group I, n = 2939) and patients aged 75 years or older (group II, n = 111) who underwent isolated coronary artery bypass grafting (CABG) during a 9-year period (January 1984 to April 1993) were analyzed to determine comparative risk factors for morbidity, early and late survival, and functional outcome.
Traditional risk factors (hypertension, hyperlipidemia, diabetes mellitus, and smoking) were significantly more prevalent in group II. The number of patients in New York Heart Association (NYHA) functional classes 3 and 4 before surgery was also significantly higher in group II (P < 0.001), but emergency operations were equally distributed between the groups. Left main-stem stenosis was more frequent in group II patients (P < 0.01), while the number of vessels involved and pre-operative left ventricular function did not differ. Both groups underwent a mean of 4.5 grafts. Internal mammary grafts were placed in 48.4% (1422/2939) in group I and 19.8% (22/111) in group II (P < 0.001). The overall peri-operative mortality rate did not differ between the groups (2.9% for group I and 2.7% for group II). Non-fatal peri-operative myocardial infarction, ventricular arrhythmias, post-extracorporeal circulation disorientation, and temporary renal insufficiency were more prevalent in group II patients (all P < 0.05). Emergency operations and re-operative CABG increased the peri-operative mortality in both groups. The 3-year survival rate was 93% and the 3-year cardiac event-free rate was 88% for the group II patients. Most of the elderly patients (98%) were in NYHA functional classes 1 and 2 at the end of the follow-up.
Even if elderly patients have a slightly higher postoperative morbidity than younger patients, and an increased mortality if operated upon in an emergency, long-term survival and freedom from cardiac events are excellent and justify the continued performance of CABG in patients aged 75 years of age or more.
分析1984年1月至1993年4月这9年间接受单纯冠状动脉旁路移植术（CABG）的75岁以下患者（I组，n = 2939）和75岁及以上患者（II组，n = 111）的数据，以确定发病、早期和晚期生存以及功能结局的比较危险因素。
传统危险因素（高血压、高脂血症、糖尿病和吸烟）在II组中更为普遍。II组术前纽约心脏协会（NYHA）功能分级为3级和4级的患者数量也显著更高（P < 0.001），但急诊手术在两组间分布均匀。II组患者左主干狭窄更为常见（P < 0.01），而受累血管数量和术前左心室功能无差异。两组平均进行了4.5次移植。I组48.4%（1422/2939）的患者使用了乳内动脉移植，II组为19.8%（22/111）（P < 0.001）。两组围手术期总死亡率无差异（I组为2.9%，II组为2.7%）。非致命性围手术期心肌梗死、室性心律失常、体外循环后定向障碍和暂时性肾功能不全在II组患者中更为普遍（均P < 0.05）。急诊手术和再次手术CABG增加了两组的围手术期死亡率。II组患者的3年生存率为93%，3年无心脏事件发生率为88%。大多数老年患者（98%）在随访结束时NYHA功能分级为1级和2级。
即使老年患者术后发病率略高于年轻患者，且急诊手术时死亡率增加，但长期生存和无心脏事件情况良好，证明对75岁及以上患者继续进行CABG手术是合理的。
