McIntosh H D, Garcia J A
Circulation. 1978 Mar;57(3):405-31. doi: 10.1161/01.cir.57.3.405.
Despite a decade of experience with aortocoronary bypass grafting embracing 300,000 or more operations, indications for its use remain controversial. The controversy persists because of a lack of adequate controls with which to compare the clinical course of operated patients; only 1248 have been reported who have been studied in a carefully controlled and random manner. Benefit has been claimed frequently by comparing the course of patients treated surgically with medically treated patients followed the decade before. Such comparisons are not valid in view of the well documented changes in the natural history of coronary artery disease that have been occurring during the last decade. Despite a low operative mortality and rate of graft closure, available data in the literature do not indicate that initial symptomatic improvement necessarily persists, or that myocardial infarctions, arrhythmias, or congestive heart failure will be prevented, or that life will be prolonged in the vast majority of operated patients.
尽管在进行了30万例或更多手术的主动脉冠状动脉搭桥手术方面已有十年经验，但其使用指征仍存在争议。由于缺乏足够的对照来比较手术患者的临床病程，争议一直存在；只有1248例患者是以精心控制和随机的方式进行研究并报告的。通过将手术治疗患者的病程与十年前接受药物治疗的患者进行比较，人们经常声称手术有好处。鉴于过去十年中冠状动脉疾病自然史中已得到充分记录的变化，这种比较是无效的。尽管手术死亡率和移植血管闭塞率较低，但文献中的现有数据并未表明最初的症状改善必然会持续，也未表明心肌梗死、心律失常或充血性心力衰竭会得到预防，或者绝大多数手术患者的寿命会延长。
