McCormick J R, Schick E C, McCabe C H, Kronmal R A, Ryan T J
J Thorac Cardiovasc Surg. 1985 May;89(5):683-8.
To identify the factors that determine operative mortality and long-term survival, we analyzed the data from 3,311 patients who underwent surgical therapy for unstable angina according to clinical presentation. Overall operative mortality was 3.9% and no differences in operative mortality were found between patients with coronary insufficiency, new-onset angina, rest angina, or changing patterns of angina. Logistic regression analysis indicated that age, left ventricular score, and presence of a left main stenosis in a left dominant circulation were related to operative mortality. The 7 year cumulative survival rate was 79%. Features predictive of long-term outcome by Cox analysis included left ventricular score, congestive heart failure score, other illness, extent of coronary disease, and cardiomegaly. Operative mortality of those patients who underwent coronary bypass during their initial hospitalization with unstable angina was similar to that of patients who were discharged and readmitted for operation at a later date. Thus, patients with unstable angina demonstrate a relatively low operative mortality, which is unrelated to the clinical presentation. Long-term survival is primarily determined by clinical and angiographic markers of left ventricular dysfunction, associated illness, and the extent of coronary disease.
为了确定决定手术死亡率和长期生存率的因素，我们根据临床表现分析了3311例因不稳定型心绞痛接受手术治疗患者的数据。总体手术死亡率为3.9%，冠状动脉供血不足、新发心绞痛、静息心绞痛或心绞痛发作模式改变的患者之间手术死亡率无差异。逻辑回归分析表明，年龄、左心室评分以及左优势循环中左主干狭窄的存在与手术死亡率相关。7年累积生存率为79%。通过Cox分析预测长期预后的特征包括左心室评分、充血性心力衰竭评分、其他疾病、冠状动脉疾病范围和心脏扩大。在首次因不稳定型心绞痛住院期间接受冠状动脉搭桥手术的患者的手术死亡率与稍后出院并再次入院接受手术的患者相似。因此，不稳定型心绞痛患者的手术死亡率相对较低，这与临床表现无关。长期生存主要由左心室功能障碍的临床和血管造影标志物、相关疾病以及冠状动脉疾病范围决定。
