Effect of Medical vs Surgical Treatment on Symptoms in Stable Angina Pectoris: The Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease
Effect of Medical vs Surgical Treatment on Symptoms in Stable Angina Pectoris: The Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease
复制标题
药物治疗与手术治疗对稳定型心绞痛症状的影响：退伍军人管理局冠状动脉闭塞性疾病手术合作研究
作者：
P. Peduzzi;H. Hultgren
一项大规模随机研究评价了药物与手术治疗对稳定型心绞痛患者症状的比较效果。我们通过问卷调查获得了有关症状和药物需求的系统信息，并设计了评分系统以提供严重程度指数。有384名患者有一份入组问卷，639名患者有一份年度问卷，329名患者有一份入组问卷和一份1年问卷。入组时存在严重程度的心绞痛和相关症状。入组时两个治疗组的症状相似。1年时，手术患者的症状显著改善。大约60%的患者有明显改善或无心绞痛，而药物治疗的患者只有16%。只有14%的手术患者在1年时没有变化或恶化，而内科患者的这一比例为56%。这些结果与其他研究报告的结果相当，这些研究检查了心绞痛手术与药物治疗的效果。在退伍军人管理局的研究中，手术患者在1年内每天服用的药物大大减少，而内科患者则适度增加。手术患者的症状缓解与移植物通畅有关，所有移植物通畅的患者有最显著的改善。在29例所有移植物闭合的患者中，1年时症状明显轻于接受药物治疗的患者。安慰剂效应或手术对疼痛的不确定影响可以解释这种现象。
The comparative effect of medical vs surgical treatment on symptoms in patients with stable angina has been evaluated in a large-scale randomized study. We obtained systematic information regarding symptoms and medication requirements by questionaire, and a scoring system was devised to provide an index of severity. Data are available on 384 patients who had an entry questionnaire, 639 with an annual questionnaire and 329 who had both an entry and a 1-year questionnaire. A severe degree of angina and associated symptoms were present at entry. Symptoms were similar in both treatment groups at entry. At 1 year, surgical patients had a significant improvement in symptoms. Approximately 60% had marked improvement or were free of angina, compared with 16% of patients treated medically. Only 14% of surgical patients were unchanged or worse at 1 year, compared with 56% of medical patients. These results are comparable to those reported by other studies that have examined the effect of surgical vs medical treatment of angina. Surgical patients in the Veterans Administration Study took substantially less daily medication at 1 year, while medical patients took moderately more. Relief of symptoms in surgical patients was related to graft patency, and patients who had all grafts patent had the most striking improvement. In 29 patients with all grafts closed, symptoms were significantly less severe at 1 year than in patients who took medical treatment. A placebo effect or an undetermined effect of surgery on pain may explain this phenomenon.