Warner C D, Weintraub W S, Craver J M, Jones E L, Gott J P, Guyton R A
Emory Healthcare, Atlanta, Ga, USA.
Circulation. 1997 Sep 2;96(5):1575-9. doi: 10.1161/01.cir.96.5.1575.
Previous studies have demonstrated increased risk in patients undergoing coronary artery bypass surgery (CABG), but the effect of this increasing risk on outcomes has not been well documented. The purposes of this study were (1) to evaluate patients who had CABG from 1993 to 1995 (group III) and compare them with patients from 1981 through 1987 (group I) and 1988 through 1992 (group II) to determine if the trend toward higher-risk patients continued and (2) to evaluate what effect risk had on in-hospital outcomes.
Data were collected prospectively on patients undergoing CABG. Patients from the three time periods were compared by use of univariate and multivariate statistics. Risk models for mortality were developed by use of logistic regression. Significant changes were noted in the three time periods, with risk increasing over time. Increased risk was associated with increased mortality in group II, but mortality declined in group III despite the continued increase in patient risk. Group II had an increase in complications, with little change in group III. The actual mortality rate was lower than predicted in group III.
Patients undergoing CABG are increasingly high risk. In-hospital mortality rates declined during the period from 1993 through 1995 and were lower than predicted despite the increase in risk. This decreased mortality rate may reflect greater experience in providing care to high-risk patients and improved myocardial protection and surgical and anesthetic techniques. Although continued analysis of patient risk and benefit is needed, researchers must be cognizant of the rapid changes in technology and knowledge and should correlate changes in the process of care with outcomes.
既往研究表明，接受冠状动脉旁路移植术（CABG）的患者风险增加，但这种风险增加对预后的影响尚未得到充分记录。本研究的目的是：（1）评估1993年至1995年接受CABG的患者（Ⅲ组），并将其与1981年至1987年（Ⅰ组）和1988年至1992年（Ⅱ组）的患者进行比较，以确定高风险患者的趋势是否持续；（2）评估风险对住院结局的影响。
前瞻性收集接受CABG患者的数据。采用单变量和多变量统计方法对三个时间段的患者进行比较。使用逻辑回归建立死亡率风险模型。在三个时间段内观察到显著变化，风险随时间增加。Ⅱ组风险增加与死亡率增加相关，但Ⅲ组尽管患者风险持续增加，死亡率却下降。Ⅱ组并发症增加，Ⅲ组变化不大。Ⅲ组实际死亡率低于预测值。
接受CABG的患者风险越来越高。1993年至1995年期间住院死亡率下降，尽管风险增加，但仍低于预测值。死亡率降低可能反映了在为高风险患者提供护理方面经验更丰富，以及心肌保护、手术和麻醉技术的改进。尽管需要继续分析患者的风险和获益，但研究人员必须认识到技术和知识的快速变化，并应将护理过程中的变化与结局相关联。
