Lawrie G M, Morris G C, Baron A, Norton J, Glaeser D H
Ann Thorac Surg. 1987 Aug;44(2):180-5. doi: 10.1016/s0003-4975(10)62037-1.
To determine which preoperative variables were most predictive of long-term survival after coronary bypass surgery, the status of 1,448 consecutive patients was determined 10 to 14 years after operation. All patients were operated on at least 10 years ago and follow-up at 10 years was 93.8% complete. The overall 14-year survival probabilities were: for one-vessel disease, 73.3%; for two-vessel disease, 45.9%; for three-vessel disease, 34.2%; and for left main coronary artery disease, 41.9%. Patients with good left ventricular function had an overall survival rate of 53.3%, and patients with poor ventricular function had a survival rate of 31.9%. Preoperative variables predictive of greater risk of total mortality were: digoxin usage, multivessel disease, poor quality of left ventricular function, age at operation, electrocardiographic evidence of myocardial infarction, previous stroke, diabetes, heart failure, diuretic usage, cigarette smoking, and residual ungrafted coronary artery disease. The major determinants of long-term survival were variables associated with preoperative left ventricular function. Diabetes was the only important metabolic risk factor identified. This study suggests that unfavorable preoperative conventional risk factors should not be considered a contraindication to operation in patients with adequate coronary anatomy and left ventricular function.
为了确定哪些术前变量最能预测冠状动脉搭桥手术后的长期生存率，对1448例连续患者在术后10至14年时的状况进行了评估。所有患者均在至少10年前接受手术，10年随访的完成率为93.8%。14年的总体生存率分别为：单支血管病变患者为73.3%；双支血管病变患者为45.9%；三支血管病变患者为34.2%；左主干冠状动脉病变患者为41.9%。左心室功能良好的患者总体生存率为53.3%，而心室功能较差的患者生存率为31.9%。预测总死亡率风险较高的术前变量包括：地高辛使用情况、多支血管病变、左心室功能质量差、手术年龄、心肌梗死的心电图证据、既往中风、糖尿病、心力衰竭、利尿剂使用情况、吸烟以及残留未搭桥的冠状动脉病变。长期生存的主要决定因素是与术前左心室功能相关的变量。糖尿病是唯一被确定的重要代谢风险因素。这项研究表明，对于冠状动脉解剖结构和左心室功能良好的患者，术前不利的传统风险因素不应被视为手术禁忌证。
