Weiner D A, Ryan T J, Parsons L, Fisher L D, Chaitman B R, Sheffield L T, Tristani F E
Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts 02118.
J Am Coll Cardiol. 1991 Aug;18(2):343-8. doi: 10.1016/0735-1097(91)90584-v.
The prevalence and prognostic significance of postoperative myocardial ischemia, as detected by exercise testing, were prospectively assessed in 174 patients from the Coronary Artery Surgery Study (CASS) randomized surgical population who had exercise testing before and 6 months after coronary artery bypass graft surgery. Whereas the prevalence of symptomatic ischemia significantly decreased postoperatively (52% vs. 6%, p less than 0.001), the frequency of silent myocardial ischemia did not change (30% vs. 29%). Survival at 12 years after bypass surgery based on the 6-month postoperative exercise test results was significantly better for the 112 patients with no ischemia (80%) than for the 51 patients with silent ischemia (68%) or the 11 patients with symptomatic ischemia (45%). These data show that coronary artery bypass graft surgery diminishes the overall prevalence of symptomatic but not silent ischemia and that both silent and symptomatic ischemia adversely affect the postoperative prognosis of these patients.
通过运动试验检测的术后心肌缺血的患病率及其预后意义，在冠状动脉搭桥手术前和术后6个月均接受运动试验的174例来自冠状动脉外科研究（CASS）随机手术人群的患者中进行了前瞻性评估。有症状缺血的患病率术后显著降低（52%对6%，p<0.001），而无症状心肌缺血的频率未改变（30%对29%）。基于术后6个月运动试验结果，112例无缺血患者搭桥手术后12年生存率（80%）显著高于51例无症状缺血患者（68%）或11例有症状缺血患者（45%）。这些数据表明，冠状动脉搭桥手术降低了有症状缺血的总体患病率，但未降低无症状缺血的患病率，并且无症状和有症状缺血均对这些患者的术后预后产生不利影响。
