LONG-TERM RESULTS OF CORONARY-BYPASS SURGERY - ANALYSIS OF 1698 PATIENTS FOLLOWED 15 TO 20 YEARS
LONG-TERM RESULTS OF CORONARY-BYPASS SURGERY - ANALYSIS OF 1698 PATIENTS FOLLOWED 15 TO 20 YEARS
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DOI：
10.1097/00000658-199105000-00001
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发表时间：
1991-05-01
影响因子：
9
通讯作者：
EARLE, N
中科院分区：
文献类型：
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作者：
LAWRIE, GM;MORRIS, GC;EARLE, N
1968年至1975年间，1968名患者接受了自体隐静脉冠状动脉搭桥术，并随访了长达20年。手术时年龄为 53.9 +/- 8.4 岁，其中 1485 名患者为男性（88%）。 1637 名患者 (96%) 出现心绞痛。 306 名患者 (18%) 存在单支血管疾病，642 名患者 (38%) 存在双支血管病变，550 名患者 (32%) 存在三支血管病变，200 名患者 (12%) 存在左主干狭窄。术前左心室质量良好的有 1185 名（70%），较差的有 508 名（30%），还有 5 名患者的情况不明。 20 年生存率如下：单支血管疾病为 40%；双血管，26%；三支血管，20%；左主线，25%。经过 20 年的随访，67% 的存活患者没有症状，26% 的病情得到改善。 49% 的患者接受抗心绞痛药物治疗，其中硝酸盐类药物占 26%，β 受体阻滞剂占 26%。 780 个移植物中有 633 个 (81%) 在 0 至 5 岁时移植物通畅； 6 至 10 年时，606 例移植物中有 415 例（68%）； 11 至 15 岁时，449 例移植物中有 271 例（60%）； 16 至 20 岁时，140 例移植物中有 65 例（46%）。 324 名患者 (19%) 接受了冠状动脉搭桥术再次手术，这些患者的生存率为 62%，而未再次手术的患者的生存率为 37% (p < 0.05)。 Cox分析表明，生存的主要决定因素与手术年龄、冠状动脉疾病程度、心室质量、中风病史和术前充血性心力衰竭有关。对这一早期冠状动脉搭桥经历进行了 20 年的随访，76% 的幸存患者接受了一个或多个专利移植物，免于再次手术的概率为 0.62。
Between 1968 and 1975, 1968 patients underwent coronary artery bypass with autogenous saphenous vein and were followed for up to 20 years. Age at operation was 53.9 +/- 8.4 years, and 1485 were men (88%). Angina was present in 1637 patients (96%). There was single-vessel disease in 306 patients (18%), double-vessel in 642 (38%), triple-vessel in 550 patients (32%) and left main stenosis in 200 (12%). Preoperative left ventricular quality was good in 1185 (70%), poor in 508 (30%), and unknown in five patients. Survival at 20 years was as follows: for single-vessel disease, 40%; double-vessel, 26%; triple-vessel, 20%; and left main, 25%. At 20 years of follow-up, 67% of surviving patients were asymptomatic and 26% were improved. Antianginal drug therapy consisted of nitrates in 49% of patients and beta-blockers in 26%. Graft patency at 0 to 5 years was 633 of 780 grafts (81%); at 6 to 10 years, 415 of 606 grafts (68%); at 11 to 15 years, 271 of 449 grafts (60%); and at 16 to 20 years, 65 of 140 grafts (46%). Coronary bypass reoperation was performed in 324 patients (19%) and survival of these patients was 62% compared to 37% for nonreoperation patients (p < 0.05). Cox analysis demonstrated that the major determinants of survival related to age at operation, extent of coronary disease, quality of ventricle, history of stroke, and preoperative congestive heart failure. At 20 years of follow-up of this early experience with coronary bypass, 76% of surviving patients had one or more patent grafts and the probability of freedom from reoperation was 0.62.