Weiner D A, Ryan T J, McCabe C H, Chaitman B R, Sheffield L T, Fisher L D, Tristani F
J Am Coll Cardiol. 1986 Oct;8(4):741-8. doi: 10.1016/s0735-1097(86)80412-0.
To determine whether exercise testing can identify patients whose survival might be prolonged by coronary artery bypass surgery, the results of bypass surgery were compared with those of medical therapy alone in 5,303 nonrandomized patients from the Coronary Artery Surgery Study registry who underwent exercise testing. Patients in the two treatment groups differed substantially with regard to important baseline variables. Analysis of 32 variables by Cox's regression model for survival revealed an independent beneficial effect of bypass surgery on survival (p less than 0.00001). Patients were then stratified into subsets according to the results of exercise testing. Surgical benefit was greatest in the 789 patients who exhibited at least 1 mm of ST segment depression and who could exercise only into stage 1 or less. Among the 398 patients with three vessel coronary disease showing these characteristics, 7 year survival was 58% for the medical group and 81% for the surgical group (p less than 0.001). There was no difference in survival between the surgical and medical groups among the 1,545 patients without ischemic ST segment depression who were able to exercise into stage 3 or greater. Thus, in patients who demonstrate ischemia on exercise testing and whose exercise capacity is limited, coronary bypass surgery appears to improve survival in comparison with medical therapy alone.
为了确定运动试验能否识别出那些通过冠状动脉搭桥手术可能延长生存期的患者，我们将冠状动脉搭桥手术的结果与冠状动脉外科研究登记处5303例接受运动试验的非随机患者单纯药物治疗的结果进行了比较。两个治疗组的患者在重要的基线变量方面存在显著差异。通过Cox生存回归模型对32个变量进行分析，结果显示搭桥手术对生存具有独立的有益作用（p小于0.00001）。然后根据运动试验结果将患者分层为不同亚组。在至少出现1毫米ST段压低且只能运动到1期或更低阶段的789例患者中，手术获益最大。在398例具有这些特征的三支冠状动脉疾病患者中，药物治疗组的7年生存率为58%，手术治疗组为81%（p小于0.001）。在能够运动到3期或更高阶段且无缺血性ST段压低的1545例患者中，手术组和药物治疗组的生存率没有差异。因此，对于运动试验显示有缺血且运动能力受限的患者，冠状动脉搭桥手术与单纯药物治疗相比似乎能提高生存率。
