Zack P M, Chaitman B R, Davis K B, Kaiser G C, Wiens R D, Ng G
Department of Medicine, St. Louis University School of Medicine, Mo.
Am Heart J. 1989 Aug;118(2):220-7. doi: 10.1016/0002-8703(89)90179-8.
Baseline, clinical, and angiographic features of 1014 Coronary Artery Surgery Study (CASS) registry patients with combined proximal left anterior descending and proximal left circumflex coronary disease were examined to define determinants of prognosis in this clinical high-risk patient subset. A stepwise Cox regression analysis identified congestive heart failure score, left ventricular contraction score, mitral regurgitation, age, and digitalis usage as independent variables predictive of 8-year survival. When patients were stratified by left ventricular contraction score, the 8-year survival rate was 62%, 49%, and 19%, respectively, for patients with a left ventricular score of 5 to 9, 10 to 14, and greater than or equal to 15 (p less than 0.0001). The presence of a stenosis greater than or equal to 70% in the right coronary artery was associated with worse survival (47% versus 54% at 8 years; p = 0.051). In conclusion, the diagnosis of combined proximal left anterior descending and left circumflex coronary artery disease represents a large prognostic spectrum that needs to be considered when counselling individual patients.
对1014例患有左前降支近端和左旋支近端合并冠心病的冠状动脉外科研究（CASS）注册患者的基线、临床和血管造影特征进行了检查，以确定这一临床高危患者亚组的预后决定因素。逐步Cox回归分析确定充血性心力衰竭评分、左心室收缩评分、二尖瓣反流、年龄和洋地黄使用情况为预测8年生存率的独立变量。当根据左心室收缩评分对患者进行分层时，左心室评分为5至9、10至14以及大于或等于15的患者的8年生存率分别为62%、49%和19%（p<0.0001）。右冠状动脉狭窄≥70%与较差的生存率相关（8年时为47%对54%；p=0.051）。总之，左前降支近端和左旋支近端合并冠心病的诊断代表了一个较大的预后范围，在为个体患者提供咨询时需要考虑这一点。
