Faxon D P, Myers W O, McCabe C H, Davis K B, Schaff H V, Wilson J W, Ryan T J
Circulation. 1986 Jul;74(1):110-8. doi: 10.1161/01.cir.74.1.110.
Coronary artery bypass surgery with or without aneurysmectomy has been used to treat patients with angiographically defined left ventricular aneurysm. To evaluate whether surgery benefits such patients, we analyzed the data from 1131 patients who were enrolled in the registry of the Coronary Artery Surgery Study. Four hundred sixty-seven patients underwent bypass surgery, of which 238 also had left ventricular resection, and 30 had resection alone. The overall operative mortality was 7.9%; the operative mortality was 7% for bypass alone compared with 9% for bypass surgery plus left ventricular resection (NS). Long-term survival by life-table analysis was similar for both medically and surgically treated patients (69% vs 67%, respectively). Cox survival analysis identified congestive heart failure score, duration of chest pain, extent of coronary disease, left ventricular end-diastolic pressure, age, and surgical therapy as important predictors of outcome. Patient subsets that showed improved survival with surgical therapy after adjustment for inequities in baseline characteristics were patients with three-vessel disease and those patients in moderate- and high-risk subgroups. Surgical therapy significantly reduced symptoms of angina and use of cardiac medications but the incidence of recurrent infarction was similar for both therapies.
冠状动脉搭桥手术（无论是否联合动脉瘤切除术）已被用于治疗血管造影确诊的左心室动脉瘤患者。为评估手术是否对这类患者有益，我们分析了纳入冠状动脉外科研究登记处的1131例患者的数据。467例患者接受了搭桥手术，其中238例还进行了左心室切除术，30例仅接受了切除术。总体手术死亡率为7.9%；单纯搭桥手术的手术死亡率为7%，而搭桥手术加左心室切除术的手术死亡率为9%（无显著性差异）。通过寿命表分析，药物治疗和手术治疗患者的长期生存率相似（分别为69%和67%）。Cox生存分析确定充血性心力衰竭评分、胸痛持续时间、冠状动脉疾病范围、左心室舒张末期压力、年龄和手术治疗是预后的重要预测因素。在对基线特征的不均衡进行调整后，手术治疗显示生存率提高的患者亚组是三支血管病变患者以及中高危亚组患者。手术治疗显著减轻了心绞痛症状和心脏药物的使用，但两种治疗方法的再发梗死发生率相似。
