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左心室功能障碍患者冠状动脉旁路手术的风险分层:冠状动脉旁路移植补丁试验数据库的分析
M Argenziano1, H M Spotnitz, W Whang
1Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. ma66@columbia.edu
Circulation
|November 24, 1999
概括
症状性心力衰竭和重复手术增加了冠状动脉旁路移植 (CABG) 患者的手术死亡率. 没有心力衰竭症状的患者可以接受CABG,降低死亡风险.
科学领域:
- 心脏病学 心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 手术前的患者特征显著影响了冠状动脉旁路移植 (CABG) 后的结果.
- 在CABG补丁试验中,研究了高风险CABG患者的预防性植入式心脏转换器-除器插入.
- 这项研究利用了CABG补丁试验数据库来检查充血性心力衰竭 (CHF) 和胸痛对心室功能障碍患者的发病率和死亡率的影响.
研究的目的:
- 调查症状充血性心力衰竭 (CHF) 和胸痛对冠状动脉旁路移植 (CABG) 患者的发病率和死亡率的影响.
- 在这个患者群体中确定增加手术死亡率和长时间停留 (LOS) 的预测因素.
主要方法:
- 对900名随机选择的患者的数据分析,喷射分数≤35%和异常的信号平均心电图.
- 使用单变量和阶段性多重物流回归来进行死亡率和LOS分析.
- 使用NYHA分类和使用CCS分类的胸痛使用CHF的分级严重程度.
主要成果:
- 与没有症状的心力衰竭的患者相比,患有症状心力衰竭的患者 (7.7%) 的术后死亡率更高 (3.5%).
- 症状性心力衰竭 (NYHA I-IV类) 和重新手术是增加死亡率的显著预测因素.
- 脑卒中史与更高的外科手术前脑卒中率和增加的LOS有关.
结论:
- 症状性心力衰竭和重新手术是CABG患者心室功能障碍手术后死亡率增加的关键预测因素.
- 没有心力衰竭症状的患者可能有相对较低的死亡率,尽管减少了射出分数.
- 高龄,中风病史以及心力衰竭的存在/严重程度显著延长了LOS.
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