Cameron A, Kemp H G, Green G E
Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY 10025.
Circulation. 1988 Sep;78(3 Pt 2):I158-62.
From a 15-year follow-up study of 743 patients who underwent initial operation for coronary artery disease, 64 patients required reoperation for recurrence of angina and were followed-up for 15 years or less (mean, 6.2 years). Patients undergoing reoperation tended to be older but not significantly so (50.9 +/- 8.3 years vs. 57.5 +/- 9.7 years), had more left main coronary artery disease (p less than 0.001), and had more triple-vessel disease (p less than 0.001) than those undergoing the initial operation. There were no significant differences in sex, prior myocardial infarctions, or prevalence of abnormal ventriculograms between the two groups. The cumulative survival rate during a 10-year follow-up period after reoperation did not differ from the rate after the initial operations. There was less relief of angina in the first year after reoperation than after initial operation, but thereafter, the annual increases in recurrence of angina were similar. Although there were more myocardial infarctions after reoperation in the first 6 postoperative years, the cumulative incidence after 10 years did not differ between the two groups. We conclude that reoperation yields a similar survival benefit but produces less early relief of angina than initial operation.
在一项针对743例接受过冠心病初次手术患者的15年随访研究中，64例患者因心绞痛复发需要再次手术，并接受了15年或更短时间的随访（平均6.2年）。接受再次手术的患者往往年龄较大，但差异不显著（50.9±8.3岁对57.5±9.7岁），与接受初次手术的患者相比，左冠状动脉主干病变更多（p<0.001），三支血管病变也更多（p<0.001）。两组在性别、既往心肌梗死或心室造影异常患病率方面无显著差异。再次手术后10年随访期内的累积生存率与初次手术后的生存率无差异。再次手术后第一年心绞痛缓解程度低于初次手术后，但此后，心绞痛复发的年增加率相似。虽然再次手术后的前6年心肌梗死更多，但两组10年后的累积发生率无差异。我们得出结论，再次手术产生的生存获益相似，但与初次手术相比，早期心绞痛缓解程度较小。
