RESUMO
BACKGROUND: Coronary artery bypass grafting (CABG) is carried out for prognosis and symptomatic relief. Smoking is associated with increased postoperative complications, although its precise influence on long-term survival is unclear. We examined the influence of smoking and other risk factors on survival and myocardial ischaemia seven years after CABG. METHODS: 208 patients underwent elective CABG; 25 % were persistent smokers. 165 were alive at seven years. 128 (78 % of survivors) agreed to reexamination and 79 had thallium scans. RESULTS: Angina and dyspnoea were reported by 52 % and 69 %, respectively, of survivors; these were associated with smoking ( P = 0.029 and 0.0 009) but with no other risk factors. Smokers had higher stress thallium scores ( P = 0.057) and ischaemia scores (10.6 +/- 6.5 vs. 6.8 +/- 6.0; P = 0.036); ejection fractions were equivalent. Obesity was prevalent and worsened in men. 33 patients (17 %) died during follow-up. Initially there was no survival difference between smokers and nonsmokers but as early as three years postoperation smoking was associated with an increased mortality ( P = 0.011; log-rank test). CONCLUSIONS: Patients experienced almost universal improvement with the operation. However, persistent smoking completely removed the prognostic benefits of CABG by accelerating late mortality which was higher than previously reported. Higher indices of ischaemia in smokers were suggested by symptoms and confirmed by perfusion scans.
Assuntos
Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Fumar/mortalidade , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Angina Pectoris/etiologia , Pressão Sanguínea , Índice de Massa Corporal , Colesterol/sangue , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Complicações do Diabetes/mortalidade , Complicações do Diabetes/cirurgia , Dispneia/etiologia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Circunferência da CinturaAssuntos
Di-Hidroxifenilalanina/metabolismo , Melanoma/metabolismo , Animais , Neoplasias do Colo/metabolismo , Feminino , Humanos , Terapia de Imunossupressão , Melanoma/patologia , Camundongos , Camundongos Endogâmicos CBA , Transplante de Neoplasias , Neoplasias Experimentais/metabolismo , Neoplasias Experimentais/patologia , Transplante HeterólogoRESUMO
A policy of early mobilization of elderly leg amputees using a simple temporary prosthesis has been assessed in the context of a district general hospital. Close cooperation between members of the hospital management team, adequate rehabilitation facilities and close liaison with the limb-fitting centre and domiciliary services were found to be essential to support this policy. Of 42 elderly amputees, 34 were supplied as early as possible with temporary prostheses. Nearly 80 per cent of them were able to walk without assistance on discharge from hospital care. Delays in discharge were mainly for socio-domestic reasons. Early prosthetic mobilization in this aged and often frail group of patients led to a reduced morbidity and mortality. There was improved morale in patients and staff, rapid clearance of acute surgical beds and the all-important early achievement of domestic mobility and independence for the amputee.
