Samaha J K, Connor M J, Tribble R, Kroetz F W, Sullivan J M, Ramanathan K B, Mirvis D M
Clin Cardiol. 1985 Aug;8(8):415-22. doi: 10.1002/clc.4960080802.
We examined the prognostic significance of an obstructive lesion in the proximal left anterior descending (LAD) coronary artery. Five-year or longer follow-up data were examined from 311 patients with greater than 70% obstruction of the LAD treated without surgery. Mortality was compared in subsets with lesions proximal to and distal to the first septal perforating artery. Survival curves were worse in patients with proximal than with distal LAD disease (p less than 0.05); lesion location remained a significant determinant of survival when ejection fraction, age, and sex were controlled using a Cox regression model. However, when patient subsets were examined, survival with proximal LAD disease was worse than with distal obstruction only in the presence of an associated right coronary artery lesion and an ejection fraction of less than 40% (p less than 0.01). Patients with proximal LAD plus right coronary lesions had a 5-year mortality rate (34.08 +/- 8.9%) that was not significantly (p greater than 0.05) different from that of a group of 66 patients with greater than 50% narrowing of the left main coronary artery (24.02 +/- 4.3%). Thus, proximal LAD disease is more significant than is a distal lesion only in the presence of right coronary obstruction. This two-vessel combination results in a mortality rate as high as that associated with left main coronary artery obstruction.
我们研究了左前降支（LAD）冠状动脉近端阻塞性病变的预后意义。对311例未经手术治疗的LAD阻塞超过70%的患者进行了5年或更长时间的随访数据检查。比较了第一间隔穿支动脉近端和远端病变亚组的死亡率。LAD近端病变患者的生存曲线比远端病变患者更差（p<0.05）；当使用Cox回归模型控制射血分数、年龄和性别时，病变位置仍然是生存的重要决定因素。然而，当检查患者亚组时，仅在存在相关右冠状动脉病变且射血分数小于40%的情况下，LAD近端病变患者的生存率才比远端阻塞患者更差（p<0.01）。LAD近端加右冠状动脉病变患者的5年死亡率（34.08±8.9%）与66例左主干冠状动脉狭窄超过50%的患者组（24.02±4.3%）相比无显著差异（p>0.05）。因此，仅在存在右冠状动脉阻塞的情况下，LAD近端病变比远端病变更具意义。这种双支血管组合导致的死亡率与左主干冠状动脉阻塞相关的死亡率一样高。
