Herlitz Johan, Brandrup-Wognsen Gunnar, Caidahl Kenneth, Haglid Maria, Hartford Marianne, Karlson Björn W, Karlsson Thomas, Sjöland Helén
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Am Heart J. 2008 Sep;156(3):580-7. doi: 10.1016/j.ahj.2008.04.017. Epub 2008 Jun 30.
The purpose of the study is to describe (a) changes in physical activity and symptoms of chest pain and dyspnea during 10 years after coronary artery bypass grafting (CABG) and (b) risk indicators for chest pain and dyspnea 10 years after CABG.
This is a prospective observational study in Western Sweden. The study includes all patients who underwent CABG without simultaneous valve surgery and with no previous CABG between June 1, 1988, and June 1, 1991. All patients were prospectively followed up for 10 years. Evaluation of symptoms took place via postal inquiries before, 5, and 10 years after the operation.
In all, 2,000 patients participated in a survey evaluating chest pain and dyspnea during 10 years after CABG. The overall 10-year mortality was 32%. The proportion of patients with no chest pain increased from 3% before surgery to 56% 5 years after the operation and 54% after 10 years. There was only one predictor for chest pain after 10 years and that was the duration of angina pectoris before surgery. The proportion of patients with no dyspnea increased from 12% before surgery to 40% after 5 years but decreased to 31% after 10 years. The most significant predictors for dyspnea after 10 years were female sex, obesity, diabetes mellitus, high age, duration of angina pectoris, functional class before CABG, and number of days in intensive care unit after CABG.
During 10 years after CABG, one third died. After 10 years, 54% of the survivors were free from chest pain and 31% were free from dyspnea. Predictors for chest pain and dyspnea could be defined and reflected age, history, sex, obesity, preoperative complications, and symptom severity.
本研究的目的是描述（a）冠状动脉旁路移植术（CABG）后10年内身体活动以及胸痛和呼吸困难症状的变化，以及（b）CABG后10年胸痛和呼吸困难的风险指标。
这是一项在瑞典西部进行的前瞻性观察性研究。该研究纳入了1988年6月1日至1991年6月1日期间接受CABG且未同时进行瓣膜手术且既往未行CABG的所有患者。所有患者均进行了为期10年的前瞻性随访。通过术后前、5年和10年的邮政询问对症状进行评估。
共有2000例患者参与了一项评估CABG后10年胸痛和呼吸困难的调查。10年总死亡率为32%。无胸痛患者的比例从术前的3%增加到术后5年的56%和10年后的54%。10年后胸痛的唯一预测因素是术前心绞痛持续时间。无呼吸困难患者的比例从术前的12%增加到5年后的40%，但10年后降至31%。10年后呼吸困难的最显著预测因素是女性、肥胖、糖尿病、高龄、心绞痛持续时间、CABG术前功能分级以及CABG后重症监护病房住院天数。
CABG后10年内，三分之一的患者死亡。10年后，54%的幸存者无胸痛，31%的幸存者无呼吸困难。可以确定胸痛和呼吸困难的预测因素，这些因素反映了年龄、病史、性别、肥胖、术前并发症和症状严重程度。
