小柯机器人

美国加州大学旧金山分校M. Maria Glymour团队比较了在接受冠状动脉重建术的老年人中，冠状动脉搭桥术与经皮冠状动脉介入治疗与记忆衰退的相关性。2021年5月18日，《美国医学会杂志》发表了这项成果。

与非手术冠状动脉重建术（经皮冠状动脉介入术[PCI]）相比，冠状动脉搭桥术（CABG）是否与老年人的认知能力下降有关尚不确定。

为了比较CABG与PCI术后记忆减退率的变化，研究组针对1998-2015年间65岁及以上接受了CABG或PCI的社区参与者进行了一项回顾性队列研究。数据建模时间为血运重建前5年和血运重建后10年，或死亡、退出或2016-2017年的集中访谈。最终随访日期为2017年11月。

主要结局为针对参与者每两年进行一次的认知测试分数和代理认知报告的汇总测量，称为记忆分数，标准化为z分数。记忆评分采用多变量线性混合效应模型进行分析，并对体外循环和非体外循环下CABG进行预先指定的亚组分析。最小临床重要差异是群体水平记忆下降率的变化为1SD。

1680名参与者的平均手术年龄为75岁，41%为女性；665例行CABG（168例非体外循环），1015例行PCI。PCI组术前平均记忆减退率为0.064记忆单位/年，术后平均记忆减退率为0.060记忆单位/年。CABG组术前平均记忆减退率为0.049记忆单位/年，术后平均记忆减退率为0.059记忆单位/年。PCI组与CABG组记忆减退的差异估计值为0.015记忆单位/年，差异不显著。非体外循环CABG术后记忆减退率较PCI术后明显增加，而体外循环CABG术后记忆减退率较PCI术后无明显增加。

研究结果表明，对于接受CABG或PCI冠状动脉血运重建术的老年人中，血运重建术的类型与记忆衰退率变化的差异无显著相关性。

附：英文原文

Title: Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization

Author: Elizabeth L. Whitlock, L. Grisell Diaz-Ramirez, Alexander K. Smith, W. John Boscardin, Kenneth E. Covinsky, Michael S. Avidan, M. Maria Glymour

Issue&Volume: 2021/05/18

Abstract:

Importance  It is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]).

Objective  To compare the change in the rate of memory decline after CABG vs PCI.

Design, Setting, and Participants  Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017.

Exposures  CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records.

Main Outcomes and Measures  The primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y).

Results  Of 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, 0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, 0.011 memory units/y [95% CI, 0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, 0.008 to 0.038; P=.21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, 0.024 to 0.031] after on-pump CABG).

Conclusions and Relevance  Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline.

DOI: 10.1001/jama.2021.5150

Source: https://jamanetwork.com/journals/jama/article-abstract/2779992

JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
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