EFFECT OF AORTOCORONARY SAPHENOUS-VEIN BYPASS GRAFTING ON DEATH AND SUDDEN-DEATH - COMPARISON OF NON-RANDOMIZED MEDICALLY AND SURGICALLY TREATED COHORTS WITH COMPARABLE CORONARY-DISEASE AND LEFT-VENTRICULAR FUNCTION
EFFECT OF AORTOCORONARY SAPHENOUS-VEIN BYPASS GRAFTING ON DEATH AND SUDDEN-DEATH - COMPARISON OF NON-RANDOMIZED MEDICALLY AND SURGICALLY TREATED COHORTS WITH COMPARABLE CORONARY-DISEASE AND LEFT-VENTRICULAR FUNCTION
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DOI：
10.1016/s0002-9149(77)80048-9
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发表时间：
1977-01-01
影响因子：
2.8
通讯作者：
DODGE, HT
中科院分区：
文献类型：
--
作者：
HAMMERMEISTER, KE;DEROUEN, TA;DODGE, HT
通过比较在冠状动脉病变程度和射血分数两个主要预后变量相似的手术和药物治疗的冠心病患者亚群的生存率，研究隐静脉旁路移植术对心源性猝死和心源性总死亡发生率的影响。在射血分数和冠心病程度相似的内科和外科亚组之间，一些基线变量存在显著差异。经医学治疗的患者往往处于较低的功能等级，有更广泛的心室收缩异常，舒张末期容积较大，可移植的远端血管较少。手术治疗的两支血管疾病患者射血分数正常或中度降低，与药物治疗的两支血管疾病和相似射血分数的患者相比，生存率提高。在手术治疗的三支血管疾病和射血分数中度降低的患者中，生存率也有临界统计学意义的提高。当根据舒张末期容积进行分类时，手术治疗的双血管疾病患者和正常或适度增加的舒张末期容积也比类似定义的药物治疗的患者生存率更高。在冠心病和射血分数相当的情况下，药物治疗患者亚组的猝死率是手术治疗患者亚组的1.8 - 10.9倍。
The effect of saphenous vein bypass grafting on the incidence of sudden cardiac death and total cardiovascular death was studied by comparing the survival of subsets of surgically and medically treated patients with coronary disease who were similar in two major prognostic variables: extent of coronary disease and ejection fraction. Significant differences in some baseline variables existed between medical and surgical subgroups with similar ejection fraction and extent of coronary disease. Medically treated patients tended to be in a lower functional class, to have more extensive ventricular contraction abnormalities, to have a larger end-diastolic volume, and to have fewer distal vessels feasible for grafting. Surgically treated patients with two vessel disease and normal or moderately reduced ejection fraction had improved survival when compared with medically treated patients with two vessel disease and similar ejection fraction. Improved survival of borderline statistical significance was also seen in surgically treated patients with three vessel disease and moderately reduced ejection fraction. When categorized according to end-diastolic volume, surgically treated patients with two vessel disease and normal or moderately increased end-diastolic volume also had improved survival over similarly defined medically treated patients. The sudden death rates for subgroups of medically treated patients were 1.8 to 10.9 times higher than the rates in subgroups of surgically treated patients with a comparable extent of coronary disease and ejection fraction.