Heart:主动脉硬化影响CABG患者预后

　　美国学者的一项研究表明，接受冠脉搭桥术（CABG）治疗的患者常见主动脉硬化，并与院内死亡或病情严重以及远期全因死亡风险升高相关，后者独立于其他危险因素。论文于2012年12月4日在线发表于《心脏》（Heart）杂志。

　　此项研究初步序贯性纳入1150例接受CABG治疗的患者；受试者术前均接受超声心动图检查。利用Logistic回归评估主动脉硬化与院内死亡和严重患病的相关性，并通过Cox比例风险模型确定其对远期全因死亡的影响。

　　结果显示，共有627例适宜患者被纳入最终分析，其中207例（33%）伴有显著主动脉硬化。主动脉硬化患者的传统心血管危险因素发生率较高。显著主动脉硬化与院内死亡或严重患病风险升高具有相关性（OR 1.95）。对基线临床和超声心动图变量进行校正之后仍具有显著相关性（OR 1.90）。在平均随访2.7年间，校正全因死亡危险比（HR）为2.52。

Aortic sclerosis is associated with mortality and major morbidity in patients undergoing coronary artery bypass surgery
Objective
In this study, we aim to investigate the association between aortic sclerosis and mortality and major morbidity in patients with established coronary artery disease undergoing coronary artery bypass grafting (CABG).
Design
Preoperative echocardiograms of consecutive patients undergoing isolated CABG between 2007 and 2009 (n=1150) were analysed, excluding patients without an echocardiogram in the 30days prior to surgery (n=483). Using logistic regression, we evaluated the association between aortic sclerosis and inhospital mortality and major morbidity. Using Cox proportional hazards, the effect on long-term all-cause mortality was determined.
Setting
Massachusetts General Hospital, Boston.
Patients
Patients undergoing isolated CABG between 2007 and 2009.
Interventions
Analysis of echocardiograms.
Main outcome measures
Inhospital mortality and major morbidity, and long-term all-cause mortality.
Results
627 patients were suitable for enrolment; 207 (33%) had significant aortic sclerosis. These patients had higher rates of traditional cardiovascular risk factors. Significant aortic sclerosis was associated with an increased risk of inhospital mortality or major morbidity (OR 1.95; 95% CI 1.25 to 3.04). Following adjustment for baseline clinical and echocardiographic variables, the association remained significant (OR 1.90; 95% CI 1.15 to 3.11). The HR for adjusted all-cause mortality was 2.52 (mean follow-up 2.7 years).
Conclusions
Aortic sclerosis is a common finding in patients undergoing CABG. In these patients, its presence is associated with a higher risk of inhospital mortality or major morbidity, and is associated with a higher risk of all-cause long-term mortality independent of other risk factors.