80岁以上高龄冠心病患者不停跳冠状动脉搭桥术死亡危险的相关性分析

Risk Factors and prediction model for mortality in octogenarians with off-pump coronary artery bypass grafting: Analysis of the Database from a Single Center of Anzhen hospital

目的探讨影响我国高龄冠心病患者非体外循环下冠状动脉搭桥术(OPCABG)死亡的危险因素并建立相关危险预测模型。方法对北京安贞医院2005年6月至2015年7月期间收治的273例80岁以上高龄患者行单纯OPCABG的资料,进行单因素分析和Logistic多因素回归分析,最终确立影响我国高龄冠心病患者OPCABG死亡的危险因素,建立相关危险预测模型,并对分析结果的校准度和分辨能力进行检验。结果本研究共纳入80岁以上高龄患者273例,全部患者接受OPCABG手术,院内死亡15例,占5.49%,中位随访时间6年,全部死亡59例,占21.61%。Logistic多因素回归分析结果提示:慢性阻塞性肺疾病(COPD)、是否急诊手术、左主干病变、是否急性心肌梗死、左室射血分数(LVEF)是本组高龄患者死亡的独立危险因素。对于模型应用Hosmer-Lemeshowχ2检验,结果为χ2=5.871,P=0.662,受试者工作特征(ROC)曲线下面积为0.877。结论 Logistic多因素回归分析结果提示,COPD、是否急诊手术、左主干病变、是否急性心肌梗死、LVEF是我国高龄冠心病患者OPCABG手术死亡的独立危险因素;由以上独立危险因素所建立的危险预测模型具有良好的校准度和分辨能力。

Objective To assess risk factors and establish prediction model for mortality in octogenarians with off-pump coronary artery bypass grafting（ OPCABG）,to supply help for medical decision and basis for medical strategy accordingly. Methods The clinical information was from the Anzhen Hospital. From June 2005 to July 2015 patients underwent OPCABG in our hospital,of whom 273 patients were aged 80 years or older. First of all the potential risk variables were identified through literature reviewing and referring other risk models. The data collection proceeded according to the potential risk factors. Univariate analysis and logistic regression were applied to find the potential risk factors. Risk factors and prediction model for mortality were confirmed. The calibration and discrimination of the prediction model were tested at last. Results 273 patients aged 80 years or older underwent isolated OPCABG were recruited. In hospital coronary operative mortality was5.49%（ 15 / 273）. Median follow- up duration was 6 years. All cause mortality rate was 21. 61 %（ 59 / 273）.Four variables： left main disease〉50%,left ventricular ejection fraction（ LVEF）,acute myocardium infraction before surgery,operative status selective or emergent were independently correlated with OPCABG operative mortality. The results of Hosmer- Lemeshow test was χ^2= 5. 871,P = 0. 662. The results of discrimination assessing by area under receiver-operating characteristic（ ROC） curve was 0.877. Conclusions The following risk factors are associated with increased operative mortality of octogenarians with off-pump coronary arterybypass grafting in China： Left main disease 50% LVEF, acute myocardium infraction before surgery,operative status selective or emergent. The prediction model established by the four potential risk factors was proven to perform well by some statistic tests.