Thomas C N, Brann S H, Douglas A R, Thomas J M, Daniel S C, Posthoff C, Rampersad K A, Angelini G D
Cardiopulmonary Research Unit, Caribbean Heart Care and Eric Williams Medical Sciences Complex, University of the West Indies, St Augustine, Trinidad and Tobago.
West Indian Med J. 2000 Dec;49(4):290-3.
The study is retrospective review of the demographic, clinical, angiographic, and operative data of the first 205 consecutive CABG operations performed by Caribbean Heart Care at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad and Tobago, between November 1993 and December 1997. The aim of the study was to determine the in-hospital and intermediate-term follow-up results. The mean age of patients was 59 +/- 10 years and 78% were male. Sixty-four per cent were of East Indian descent, whereas 16% were of African descent. Forty-eight per cent of the patients were hypertensive, 46% were diabetic, 33% had hyperlipidaemia, 20% had a recent history of cigarette smoking and 16% were obese. Sixty-five per cent had a positive family history of ischaemic heart disease. The average time interval between angiography and surgery was 2.3 months. At the time of angiography, 63.5% of patients had Canadian Cardiac Society (CCS) class 3 or 4 angina. The mean ejection fraction was 61 +/- 15%. Wall motion abnormalities were seen in 67% of patients. Significant stenoses of the left anterior descending artery, right circumflex artery, circumflex and ramus coronary arteries were present in 91%, 78%, 54% and 5%, respectively. Many patients (67%) had severe diffuse disease on angiography. The mean intensive care stay was 2.2 +/- 0.8 days. In-hospital mortality was 3.9% (8/205). The most frequent post-operative complication was haemorrhage (2.6%). Acute renal failure occurred in 2.1%; pulmonary collapse, 1.6%; stroke, 1% and cardiac arrest, 1%. Both sternal wound infections and systemic sepsis occurred in 0.5%. Intermediate-term follow-up data were obtained for 92% (189/205). The duration of follow-up ranged from 1 to 5 years (mean 3.7 years). During the follow-up period, 7 patients (3.4%) died. Angina severity was reduced from a mean CCS score of 2.61 +/- 0.95 before CABG to 1.22 +/- 0.55 at the time of follow-up (p < 0.0001). Overall 4-year mortality compared favourably with data from international studies. Among survivors, quality of life improved as evidenced by the reduction in the mean angina score.
本研究回顾性分析了1993年11月至1997年12月期间，加勒比心脏护理中心在特立尼达和多巴哥的埃里克·威廉姆斯医学科学综合大楼（EWMSC）连续进行的前205例冠状动脉旁路移植术（CABG）的人口统计学、临床、血管造影和手术数据。本研究的目的是确定住院期间及中期随访结果。患者的平均年龄为59±10岁，78%为男性。64%为东印度裔，16%为非洲裔。48%的患者患有高血压，46%患有糖尿病，33%患有高脂血症，20%有近期吸烟史，16%肥胖。65%有缺血性心脏病家族史阳性。血管造影与手术之间的平均时间间隔为2.3个月。血管造影时，63.5%的患者有加拿大心血管学会（CCS）3级或4级心绞痛。平均射血分数为61±15%。67%的患者可见室壁运动异常。左前降支、右冠状动脉回旋支、冠状动脉回旋支和分支的严重狭窄分别为91%、78%、54%和5%。许多患者（67%）在血管造影时有严重弥漫性病变。平均重症监护病房停留时间为2.2±0.8天。住院死亡率为3.9%（8/205）。最常见的术后并发症是出血（2.6%）。急性肾衰竭发生率为2.1%；肺不张为1.6%；中风为1%；心脏骤停为1%。胸骨伤口感染和全身性败血症均为0.5%。92%（189/205）的患者获得了中期随访数据。随访时间为1至5年（平均3.7年）。随访期间，7例患者（3.4%）死亡。心绞痛严重程度从CABG术前平均CCS评分为2.61±0.95降至随访时的1.22±0.55（p<0.0001）。总体4年死亡率与国际研究数据相比更有利。在幸存者中，生活质量有所改善，平均心绞痛评分降低证明了这一点。
