Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Eur J Cardiothorac Surg. 2010 Jan;37(1):112-8. doi: 10.1016/j.ejcts.2009.06.018. Epub 2009 Aug 3.
To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting (CABG) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years.
Prospective observational study in western Sweden.
All patients who underwent first-time CABG, without simultaneous valve surgery, between 1 June 1988 and 1 June 1991. There were no exclusion criteria.
FOLLOW-UP: All patients were followed up prospectively for 15 years. The evaluation of symptoms took place through postal questionnaires prior to and 5, 10 and 15 years after the operation.
Totally, 2000 patients were included in the survey and 904 (45%) of them survived to 15 years. Among these 904 survivors, the percentage of patients with chest pain increased from 44% to 50% between the 5- and 15-year follow-up (p=0.004). The percentage of patients who reported symptoms of dyspnoea increased from 60% after 5 years to 74% after 15 years (p<0.001). Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age (p=0.04) and prolonged duration of symptoms prior to surgery (p=0.04). Predictors of dyspnoea after 15 years were higher age (p<0.0001), the use of inotropic drugs at the time of surgery (p=0.001), a history of diabetes (p=0.01) and obesity (p=0.01).
After CABG, relief from chest pain and dyspnoea is generally maintained over a long period of time. Eventually, however, functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain, while three-quarters report dyspnoea after 15 years. Even if no clear predictor of chest pain was found at the time of surgery, age, the use of inotropic drugs, diabetes and obesity predicted dyspnoea.
描述冠状动脉旁路移植术（CABG）后 15 年期间胸痛和呼吸困难的变化，并确定手术时与 15 年后发生这些症状相关的因素。
瑞典西部的前瞻性观察研究。
所有于 1988 年 6 月 1 日至 1991 年 6 月 1 日期间首次接受单纯 CABG 而无同期瓣膜手术的患者。无排除标准。
所有患者均前瞻性随访 15 年。症状评估通过手术前及术后 5、10 和 15 年的邮寄问卷进行。
共有 2000 例患者纳入调查，其中 904 例（45%）存活至 15 年。在这 904 例存活者中，胸痛患者的百分比从 5 年随访时的 44%增加至 15 年随访时的 50%（p=0.004）。报告呼吸困难症状的患者百分比从 5 年后的 60%增加至 15 年后的 74%（p<0.001）。手术时独立倾向于预测 15 年后胸痛的因素为较高的年龄（p=0.04）和术前症状持续时间延长（p=0.04）。15 年后呼吸困难的预测因素为较高的年龄（p<0.0001）、手术时使用正性肌力药物（p=0.001）、糖尿病史（p=0.01）和肥胖症（p=0.01）。
CABG 后，胸痛和呼吸困难的缓解通常可维持较长时间。然而，最终功能受限症状往往会再次出现，大约一半的患者报告胸痛症状，而四分之三的患者在 15 年后报告呼吸困难。即使在手术时未发现胸痛的明确预测因素，年龄、正性肌力药物的使用、糖尿病和肥胖症仍预测呼吸困难。
