THE EVOLUTION OF MEDICAL AND SURGICAL THERAPY FOR CORONARY-ARTERY DISEASE - A 15-YEAR PERSPECTIVE
THE EVOLUTION OF MEDICAL AND SURGICAL THERAPY FOR CORONARY-ARTERY DISEASE - A 15-YEAR PERSPECTIVE
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DOI：
10.1001/jama.261.14.2077
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发表时间：
1989-04-14
影响因子：
120.7
通讯作者：
PRYOR, DB
中科院分区：
文献类型：
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作者：
CALIFF, RM;HARRELL, FE;PRYOR, DB
为了阐明冠状动脉搭桥术后提高存活率的相关因素，我们研究了5809名接受内科或外科治疗的冠心病患者。有三个因素与显著的手术生存益处相关：更严重的冠状动脉疾病，更差的药物治疗预后，以及更近的手术日期。冠脉阻塞范围越广的患者存活率改善最大。由于年龄较大、严重心绞痛或左心功能不全等因素而预后较差的患者，其风险降低与他们接受药物治疗的总体风险成比例。在研究期间，手术的存活率逐渐提高，到1984年，对于大多数患者亚组来说，手术明显好于药物治疗。因此，当代冠状动脉血运重建与许多缺血性心脏病患者的寿命延长有关，特别是在那些预后指标不良的患者中。
To elucidate the factors associated with improved survival following coronary artery bypass surgery, we studied 5809 patients receiving medical or surgical therapy for coronary artery disease. Three factors were associated with a significant surgical survival benefit: more severe coronary disease, a worse prognosis with medical therapy, and a more recent operative date. Patients with more extensive coronary obstruction had the greatest improvement in survival. Patients with a poor prognosis because of factors such as older age, severe angina, or left ventricular dysfunction had a reduction in risk that was proportionate to their overall risk on medical therapy. Survival with surgery progressively improved over the study period and by 1984 surgery was significantly better than medical therapy for most patient subgroups. Thus, contemporary coronary revascularization is associated with improved longevity in many patients with ischemic heart diease, especially in those with adverse prognostic indicators.