Doogue M, Brett C, Elliott J M
Department of Medicine, Christchurch School of Medicine.
N Z Med J. 1997 Feb 14;110(1037):26-30.
To assess the baseline characteristics of patients referred for isolated coronary bypass surgery (CABG), waiting times for coronary bypass surgery and clinical events while waiting for coronary bypass surgery. To compare the New Zealand priority scoring system with a previously validated Ontario urgency score.
Outcomes in a consecutive case series of 88 patients referred from Christchurch Hospital for coronary bypass surgery between July 1 and December 31 1993 were compared with a previous Christchurch case series and a contemporary Canadian case series. Patients were stratified according to both Ontario and New Zealand priority scores.
Of 88 patients, one patient died prior to surgery, 79 had undergone coronary bypass surgery (with three deaths), and eight were still waiting as at December 31 1995. Twenty five percent of patients had left main disease, another 60% had multivessel disease that included the proximal left anterior descending coronary artery and 64% had angina at rest or on minimal exertion. The median waiting time was 92 days (inter-quartile range 20-234), 8 (6-12) days in the 23 patients who underwent surgery as in-hospital cases, and 181 (83-295) in those who waited at home. Patients with left main disease waited a median of 41 (11-205) days. While waiting at home one patient died, one patient suffered a myocardial infarction, and 17 patients were readmitted with unstable angina. Readmissions were not predicted by New Zealand or Ontario priority scores, nor by clinical variables.
Thresholds for referral are very similar, but waiting times for coronary bypass surgery are far longer in New Zealand than Canada. The long waiting times are a considerable cost to both patients and government. Priority scores facilitate comparison between countries but they may not predict readmission to hospital while on a long waiting list.
评估接受单纯冠状动脉搭桥手术（CABG）患者的基线特征、冠状动脉搭桥手术的等待时间以及等待冠状动脉搭桥手术期间的临床事件。比较新西兰优先评分系统与先前验证的安大略省紧急程度评分。
将1993年7月1日至12月31日期间从克赖斯特彻奇医院转诊接受冠状动脉搭桥手术的88例连续病例系列的结果与先前的克赖斯特彻奇病例系列和当代加拿大病例系列进行比较。根据安大略省和新西兰的优先评分对患者进行分层。
88例患者中，1例在手术前死亡，79例接受了冠状动脉搭桥手术（3例死亡），截至1995年12月31日，8例仍在等待。25%的患者患有左主干病变，另外60%患有多支血管病变，包括近端左前降支冠状动脉，64%的患者在静息或轻微运动时出现心绞痛。中位等待时间为92天（四分位间距20 - 234天），23例住院手术患者的等待时间为8（6 - 12）天，在家等待的患者为181（83 - 295）天。患有左主干病变的患者中位等待时间为41（11 - 205）天。在家等待期间，1例患者死亡，1例患者发生心肌梗死，17例患者因不稳定型心绞痛再次入院。再次入院情况无法通过新西兰或安大略省的优先评分或临床变量预测。
转诊阈值非常相似，但新西兰冠状动脉搭桥手术的等待时间比加拿大长得多。漫长的等待时间对患者和政府来说都是相当大的成本。优先评分有助于国家间的比较，但在长等待名单上时，它们可能无法预测再次入院情况。
