摘要
背景:慢性阻塞性肺病(COPD)与接受冠状动脉搭桥术(CABG)患者的院内死亡率增加有关,而关于其对长期生存率的影响仍所知较少。本研究中确定了COPD对CABG术后生存率的影响。方法和结果:作者对1992—2001年间在新英格兰北部行单一CABG术的33137例连续患者进行了前瞻性研究。病历档案与全国死亡指数关联以获得长期死亡率数据。采用Cox比例风险回归模型计算风险比(HR)。
BACKGROUND -Chronic obstructive pulmonary disease(COPD) is associated with increased in-hospital mortality in patients undergoing coronary artery bypass surgery(CABG). Long-term survival is less well understood. The present study examined the effect of COPD on survival after CABG. METHODS AND RESULTS -We conducted a prospective study of 33 137 consecutive isolated CABG patients between 1992 and 2001 in northern New England. Records were linked to the National Death Index for long-term mortality data. Cox proportional hazards regression was used to calculate hazard ratios(HRs). Patients were stratified by: no comorbidities(none), COPD, COPD plus comorbidities, and other comorbidities with no COPD. There were 131 434 person years of follow-up and 5344 deaths. The overall incidence rate(deaths per 100 person years) was 4.1. By group, rates were: 2.1(none), 4.0(COPD alone), 5.5(other), and 9.4(COPD plus; log rank P< 0.001). After adjustment, survival with COPD alone was worse compared with none(HR, 1.8; 95%CI, 1.6 to 2.1; P< 0.001). Patients with other comorbidities compared with none had even worse survival(HR, 2.2; 95%CI, 2.1 to 2.4; P< 0.001). Patients with COPD plus other comorbidities compared with none had the worst long-term survival(HR, 3.6; 95%CI, 3.3 to 3.9; P< 0.001). CONCLUSIONS -Patients with only COPD had significantly reduced long-term survival compared with patient with no comorbidities. Patients with COPD and ≥1 other comorbidity had the worst survival rate when compared with all of the other groups.
