Tu J V, Naylor C D, Kumar D, DeBuono B A, McNeil B J, Hannan E L
Institute for Clinical Evaluative Sciences and Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Ann Intern Med. 1997 Jan 1;126(1):13-9. doi: 10.7326/0003-4819-126-1-199701010-00002.
Previous studies have shown that the rate of coronary artery bypass graft (CABG) surgery is much higher in New York State than in Ontario.
To compare the service context and clinical characteristics of patients having CABG surgery in New York and Ontario.
Retrospective analysis of data from cardiac surgery registries in New York and Ontario.
All 16,690 patients in New York and 5517 patients in Ontario who had isolated CABG surgery in 1993.
Clinical characteristics of patients having CABG surgery and rates of CABG surgery by coronary anatomy.
The overall age-adjusted rate of isolated CABG surgery was 1.79 times (95% CI, 1.74 to 1.85) greater in New York than in Ontario. Patients who had CABG surgery in New York were more likely to be elderly and female and to have recently had myocardial infarction (P < 0.001), whereas patients who had CABG surgery in Ontario were more likely to have had left ventricular dysfunction and severe coronary artery disease (two-vessel disease with proximal left anterior descending disease, three-vessel disease, or left main disease) (P < 0.001). The relative rate of CABG surgery for left main disease was 2.53 times (CI, 2.35 to 2.73) greater in New York than in Ontario but was 8.97 times (CI, 8.01 to 10.06) greater for patients with limited coronary artery disease (one-vessel or two-vessel disease without proximal left anterior descending disease).
The higher rates of CABG surgery in New York are associated with higher rates of CABG surgery among the elderly, women, and patients who recently had myocardial infarction. Potential underservicing in Ontario is suggested by a lower rate of CABG surgery for left main disease; however, the higher rate of CABG surgery in New York is also associated with a strikingly higher rate of surgery in patients with limited coronary disease. Such trade-offs highlight the difficulty of defining an optimal rate of CABG surgery.
先前的研究表明，纽约州冠状动脉搭桥术（CABG）的手术率远高于安大略省。
比较纽约州和安大略省接受CABG手术患者的服务背景和临床特征。
对纽约州和安大略省心脏外科登记处的数据进行回顾性分析。
1993年在纽约州接受单纯CABG手术的16690例患者以及在安大略省接受该手术的5517例患者。
接受CABG手术患者的临床特征以及按冠状动脉解剖结构划分的CABG手术率。
纽约州单纯CABG手术的总体年龄调整率比安大略省高1.79倍（95%可信区间为1.74至1.85）。在纽约接受CABG手术的患者更可能是老年人、女性且近期发生过心肌梗死（P<0.001），而在安大略接受CABG手术的患者更可能存在左心室功能障碍和严重冠状动脉疾病（双支血管病变伴左前降支近端病变、三支血管病变或左主干病变）（P<0.001）。纽约州左主干病变的CABG手术相对率比安大略省高2.53倍（可信区间为2.35至2.73），但对于冠状动脉疾病有限（单支或双支血管病变且无左前降支近端病变）的患者，该相对率高8.97倍（可信区间为8.01至10.06）。
纽约州较高的CABG手术率与老年人、女性及近期发生心肌梗死患者中较高的CABG手术率相关。左主干病变的CABG手术率在安大略省较低，提示可能存在服务不足的情况；然而，纽约州较高的CABG手术率也与冠状动脉疾病有限的患者中显著更高的手术率相关。这些权衡凸显了确定CABG手术最佳率的困难。
