Moise A, Bourassa M G, Théroux P, Taeymans Y, Pasternac A, Campeau L, Bois M A, Dyrda I, David P R
Am J Cardiol. 1985 Apr 1;55(8):941-6. doi: 10.1016/0002-9149(85)90722-2.
Angiographically documented coronary artery disease (CAD) can progress. Although progression itself is frequently recognized in patients who have undergone repeat cardiac catheterization, its prognostic significance remains unclear. To evaluate the influence of progression on survival, 313 patients with CAD who underwent catheterization twice (39 +/- 25 months apart) were followed for 3 to 129 months (mean 41 +/- 30) after the second angiogram. At the time of the second angiogram, 21, 91, 113 and 88 patients had 0-, 1-, 2- and 3-vessel CAD, respectively. The mean ejection fraction (EF) of the group was 55 +/- 13%. Progression was noted in 139 patients (44%). Of the 313 patients, 33 died and 39 had acute myocardial infarction (AMI) during follow-up. Four-year survival was estimated at 94% and 83% in the nonprogression and progression groups, respectively. Progression was predictive of survival by (univariate) long-rank test (p less than 0.01), but only EF (p less than 0.001), number of diseased vessels (p less than 0.01) and percent stenosis in the left main coronary artery (p less than 0.05) were independently significant by (multivariate) Cox regression analysis. Four-year survival without AMI was 89% and 73% in the nonprogression and progression groups, respectively. Progression was related to survival without AMI (p less than 0.001) by log-rank test. Cox regression analysis provided 3 independent predictors of survival without AMI: number of diseased vessels (p less than 0.01), progression (p less than 0.01), relative risk = 2.28) and EF (p less than 0.01). Results were similar when analyzing only the 39 AMIs.(ABSTRACT TRUNCATED AT 250 WORDS)
血管造影证实的冠状动脉疾病（CAD）会进展。尽管在接受重复心脏导管插入术的患者中经常能认识到病情进展本身，但它的预后意义仍不明确。为了评估病情进展对生存的影响，对313例接受了两次导管插入术（两次间隔39±25个月）的CAD患者在第二次血管造影后进行了3至129个月（平均41±30个月）的随访。在第二次血管造影时，分别有21、91、113和88例患者患有0支、1支、2支和3支血管的CAD。该组的平均射血分数（EF）为55±13%。139例患者（44%）出现了病情进展。在313例患者中，33例在随访期间死亡，39例发生了急性心肌梗死（AMI）。非进展组和进展组的4年生存率分别估计为94%和83%。通过（单变量）长秩检验，病情进展可预测生存（p<0.01），但通过（多变量）Cox回归分析，只有EF（p<0.001）、病变血管数量（p<0.01）和左主干冠状动脉狭窄百分比（p<0.05）具有独立显著性。非进展组和进展组无AMI的4年生存率分别为89%和73%。通过对数秩检验，病情进展与无AMI的生存相关（p<0.001）。Cox回归分析提供了无AMI生存的3个独立预测因素：病变血管数量（p<0.01）、病情进展（p<0.01，相对风险=2.28）和EF（p<0.01）。仅分析39例AMI时结果相似。（摘要截短于250字）
