Kronenfeld J J, Charles E D, Wayne J B, Oberman A, Kouchoukos N T, Rogers W J, Mantle J A, Rackley C E, Russell R O
Circulation. 1979 Aug;60(2 Pt 2):16-22. doi: 10.1161/01.cir.60.2.16.
Debate exists over the most appropriate form of treatment for patients with unstable angina pectoris. This study examined 106 patients randomized at the University of Alabama in Birmingham as part of the National Cooperative Study Group and focuses on the phenomenon of patients who fail medical therapy and thus require late surgery, and the costs of therapy. Discriminant function analysis revealed that the significant predictors (p less than 0.01) of patients who would later require surgery were: total number of vessels diseased, angina severly, presence of congestive heart failure, hypertension, and number of years that the patient had had angina. By means of this analysis, 85% of the late surgery patients were correctly predicted. Late surgery patients averaged 2.4 diseased vessels vs 1.5 for persistent medical patients (p less than 0.01). Mean charges for the first 2 years in the study were $6,226 (SD $2,967) for persistent medical patients, $10,416 (SD $2,146) for surgery patients, and $20,059 (SD $10,748) for late surgery patients (p less than 0.001). These data indicate that surgery is clearly an expensive procedure; but that it is more expensive for late surgery patients, who have total costs that are twice as high as surgical costs and 3.5 times as high as persistent medical costs.
对于不稳定型心绞痛患者最恰当的治疗形式存在争议。本研究调查了106名在阿拉巴马大学伯明翰分校随机分组的患者，这些患者是国家合作研究组研究的一部分，研究重点是药物治疗失败因而需要后期手术的患者现象以及治疗费用。判别函数分析显示，后期需要手术的患者的显著预测因素（p<0.01）为：病变血管总数、心绞痛严重程度、充血性心力衰竭的存在、高血压以及患者患心绞痛的年数。通过该分析，85%的后期手术患者被正确预测。后期手术患者平均有2.4支病变血管，而持续接受药物治疗的患者为1.5支（p<0.01）。研究中前两年持续接受药物治疗患者的平均费用为6226美元（标准差2967美元），手术患者为10416美元（标准差2146美元），后期手术患者为20059美元（标准差10748美元）（p<0.001）。这些数据表明，手术显然是一种昂贵的治疗手段；但对于后期手术患者来说更为昂贵，他们的总费用是手术费用的两倍，是持续接受药物治疗费用的3.5倍。
