USE OF SURVIVAL ANALYSIS TO DETERMINE THE CLINICAL-SIGNIFICANCE OF NEW Q-WAVES AFTER CORONARY-BYPASS SURGERY
USE OF SURVIVAL ANALYSIS TO DETERMINE THE CLINICAL-SIGNIFICANCE OF NEW Q-WAVES AFTER CORONARY-BYPASS SURGERY
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DOI：
10.1161/01.cir.67.2.302
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发表时间：
1983-01-01
期刊：
影响因子：
37.8
通讯作者：
KILLIP, T
中科院分区：
文献类型：
--
作者：
CHAITMAN, BR;ALDERMAN, EL;KILLIP, T
关于新Q波对冠状动脉搭桥手术（CABG）后生存率和发病率的长期影响的数据很少。我们对1978年在10家参与冠状动脉手术研究（CASS）的医院接受冠脉搭桥术的1340例患者进行了随访。围手术期q波梗死发生率为4.6%（各医院范围为0.0 ~ 10.3%）。术前胸片显示左室舒张末期压升高或心脏增大的患者梗死发生率较高。接受较多移植物或较长体外循环时间的患者发生梗死的风险也较高。在对44个临床、血管造影和手术变量的逐步判别分析中，体外循环时间、局部心脏低温和心脏扩大进入了逐步选择的变量。术后出现新的Q波对长期生存有不利影响。术后出现新Q波的62例患者住院死亡率为9.7%，未出现新Q波的1278例患者住院死亡率为1.0% (P < 0.001)；3年累计生存率分别为85%和95% （P < 0.001）。在存活至出院的患者中，新的术后Q波的存在对3年生存率没有不利影响（分别为94%和96%）。有梗死史或术前左心室功能受损的患者生存率更差。经壁围手术期梗死患者与无经壁围手术期梗死患者在冠脉搭桥后再入院的次数相似。显然，冠状动脉搭桥后新Q波的出现对存活有不利影响。对死亡率的主要影响发生在出院前。术前和血管造影变量不能预测围手术期梗死的患者。
There are few data on the long-term effects on new Q waves on survival and morbitidty after coronary bypass graft surgery (CABG). Patients (1340) who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS) were followed. The incidence of perioperative Q-wave infarction was 4.6% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical cardiac hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hosptial mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (P < 0.001); the 3-yr cumulative survival rates were 85 and 95%, respectively (P < 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-yr survival (94 and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to that among patients who did not. Apparenty, the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiogrpahic variables.