PDF(Pubmed)
Abstract：
UNASSIGNED: There is a lack of evidence associating intraoperative transoesophageal echocardiography (TOE) use with improved outcomes among coronary artery bypass graft (CABG) surgery subpopulations.
UNASSIGNED: This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with vs without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.
UNASSIGNED: Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% vs 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71-0.92; P=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% vs 5.26% (OR: 0.78; 95% CI: 0.66-0.94; P=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% vs 5.24% (OR: 0.80; 95% CI: 0.65-0.97; P=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% vs 2.15% (OR: 0.85; 95% CI: 0.70-1.02; P=0.089, nor any of the remaining three subgroups.
UNASSIGNED: Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (vs without) and among patients undergoing multivessel (vs single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.
UNASSIGNED: This matched retrospective cohort study used a US private claims dataset to compare outcomes among different CABG surgery patient populations with vs without TOE. Statistical analyses involved exact matching on pre-selected subgroups (congestive heart failure, single vessel, and multivessel CABG) and used fine and propensity-score balanced techniques to conduct multiple matched comparisons and sensitivity analyses.
UNASSIGNED: Of 42 249 patients undergoing isolated CABG surgery, 24 919 (59.0%) received and 17 330 (41.0%) did not receive TOE. After matching, intraoperative TOE was significantly associated with a lower, 30-day mortality: 2.63% vs 3.20% (odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.71-0.92; P=0.002). In the subgroup matched comparisons, intraoperative TOE was significantly associated with a lower, 30-day mortality rate among those with congestive heart failure: 4.20% vs 5.26% (OR: 0.78; 95% CI: 0.66-0.94; P=0.007) and among those undergoing multivessel CABG with congestive heart failure: 4.23% vs 5.24% (OR: 0.80; 95% CI: 0.65-0.97; P=0.025), but not among those undergoing multivessel CABG without congestive heart failure: 1.83% vs 2.15% (OR: 0.85; 95% CI: 0.70-1.02; P=0.089, nor any of the remaining three subgroups.
UNASSIGNED: Among US adults undergoing isolated CABG surgery, intraoperative TOE was associated with improved outcomes in patients with congestive heart failure (vs without) and among patients undergoing multivessel (vs single vessel) CABG. These findings support prioritised TOE allocation to these patient populations at centres with limited TOE capabilities.
摘要：
■在冠状动脉旁路移植术（CABG）手术亚群中，术中经食管超声心动图（TOE）的使用与改善预后相关的证据缺乏。
■这项匹配的回顾性队列研究使用了美国私人索赔数据集，以比较不同CABG手术患者人群与无TOE的结果。统计分析涉及预选亚组的精确匹配(充血性心力衰竭，单船,和多血管CABG），并使用精细和倾向得分平衡技术进行多重匹配比较和敏感性分析。
■在42249例接受单独CABG手术的患者中，收到24919人（59.0%）和17330人（41.0%）未收到TOE。匹配后,术中TOE显著相关,30天死亡率：2.63%vs3.20%（比值比[OR]：0.81；95%置信区间[CI]：0.71-0.92；P=0.002）。在分组匹配比较中，术中TOE显著相关,充血性心力衰竭患者的30天死亡率：4.20％vs5.26％（OR：0.78；95％CI：0.66-0.94；P=0.007），而充血性心力衰竭患者的30天死亡率：4.23％vs5.24％（OR：0.80；95％CI：0.65-0.97；P=0.025），但在没有充血性心力衰竭的患者中没有：1.83％vs2.15％（OR：0.85；95％CI：0.70-1.02；P=0.089，其余三个亚组也没有。
■在接受单独CABG手术的美国成年人中，术中TOE与充血性心力衰竭患者(与无充血性心力衰竭患者)和接受多支血管(与单支血管CABG患者)的预后改善相关.这些发现支持在TOE能力有限的中心将TOE优先分配给这些患者人群。
■这项匹配的回顾性队列研究使用了美国私人索赔数据集，以比较不同CABG手术患者人群与无TOE的结果。统计分析涉及预选亚组的精确匹配(充血性心力衰竭，单船,和多血管CABG），并使用精细和倾向得分平衡技术进行多重匹配比较和敏感性分析。
■在42249例接受单独CABG手术的患者中，收到24919人（59.0%）和17330人（41.0%）未收到TOE。匹配后,术中TOE显著相关,30天死亡率：2.63%vs3.20%（比值比[OR]：0.81；95%置信区间[CI]：0.71-0.92；P=0.002）。在分组匹配比较中，术中TOE显著相关,充血性心力衰竭患者的30天死亡率：4.20％vs5.26％（OR：0.78；95％CI：0.66-0.94；P=0.007），而充血性心力衰竭患者的30天死亡率：4.23％vs5.24％（OR：0.80；95％CI：0.65-0.97；P=0.025），但在没有充血性心力衰竭的患者中没有：1.83％vs2.15％（OR：0.85；95％CI：0.70-1.02；P=0.089，其余三个亚组也没有。
■在接受单独CABG手术的美国成年人中，术中TOE与充血性心力衰竭患者(与无充血性心力衰竭患者)和接受多支血管(与单支血管CABG患者)的预后改善相关.这些发现支持在TOE能力有限的中心将TOE优先分配给这些患者人群。
