Verska J J, Walker W J
Am J Cardiol. 1975 Jun;35(6):774-7. doi: 10.1016/0002-9149(75)90111-3.
ONe hundred twelve patients undergoing aortocoronary bypass--35 with diabetes of adult onset and 77 without diabetes--were studied to determine whether diabetic patients have additional operative risks and greater operative mortality and whether their coronary disease differs from that of nondiabetic patients. Among the diabetic patients there was a greater prevalence of preoperative unstable angina, prior myocardial infarction and class IV functional disability (New York Heart Association criteria). The major coronary arteries angiographically and at operation appeared similar in both groups. The blood flow rates measured in aortocoronary bypass vein grafts were similar in both groups, raising doubt about the presence of microvascular disease in the myocardium of the diabetic patient. Preliminary follow-up results demonstrated relief of anginal symptoms in 76 percent of diabetic and 78 percent of nondiabetic patients. The operative mortality rate of 9 percent in diabetic and 4 percent in nondiabetic patients occurred among the first 40 patients in the series; no patient in either group has died in the immediate postoperative period during the last 18 months of the study. Aortocoronary bypass should be recommended to diabetic patients with symptomatic coronary arteriosclerosis using the same criteria for operability applied to the nondiabetic population.
对112例行主动脉冠状动脉搭桥术的患者进行了研究，其中35例为成年起病的糖尿病患者，77例无糖尿病，以确定糖尿病患者是否存在额外的手术风险和更高的手术死亡率，以及他们的冠状动脉疾病是否与非糖尿病患者不同。糖尿病患者术前不稳定型心绞痛、既往心肌梗死和IV级功能残疾（纽约心脏协会标准）的患病率更高。两组患者的主要冠状动脉在血管造影和手术中的表现相似。两组患者主动脉冠状动脉搭桥静脉移植物的血流速度相似，这使人怀疑糖尿病患者心肌中是否存在微血管疾病。初步随访结果显示，76%的糖尿病患者和78%的非糖尿病患者心绞痛症状得到缓解。该系列前40例患者中，糖尿病患者的手术死亡率为9%，非糖尿病患者为4%；在研究的最后18个月中，两组患者均无术后即刻死亡病例。对于有症状的冠状动脉粥样硬化糖尿病患者，应使用适用于非糖尿病人群的相同手术标准推荐行主动脉冠状动脉搭桥术。
