Lytle B W, Kramer J R, Golding L R, Cosgrove D M, Borsh J A, Goormastic M, Loop F D
J Am Coll Cardiol. 1984 Sep;4(3):445-53. doi: 10.1016/s0735-1097(84)80086-8.
This study reviews data on 107 patients, aged 35 years or younger, who underwent surgical coronary revascularization from 1971 to 1975. Early clinical events included one operative death and five nonfatal perioperative myocardial infarctions. Late follow-up (mean interval after operation 115 months) demonstrated actuarial survival rates of 94% at 5 years and 85% at 10 years. Fifteen late deaths, 23 nonfatal myocardial infarctions, 13 reoperations and return of severe angina in 10 patients were considered late clinical events. Actuarial survival free of early or late clinical events was 77% at 5 years and 53% at 10 postoperative years. Testing of clinical, angiographic and operative variables for influence on survival and event-free survival showed that survival was decreased by multivessel disease and impaired left ventricular function; event-free survival was decreased by a family history of coronary disease and cigarette smoking. Both survival and event-free survival were decreased by diabetes and elevated serum cholesterol. Postoperative cardiac catheterization (64 patients, mean postoperative interval 47 months) demonstrated that mammary artery graft patency (25 of 27, 93%) exceeded vein graft patency (49 of 88, 56%, p less than 0.01). The atherogenic diatheses of young adults may compromise the operative result, whereas use of internal mammary artery grafts may enhance the palliation of bypass surgery.
本研究回顾了1971年至1975年间接受外科冠状动脉血运重建术的107例35岁及以下患者的数据。早期临床事件包括1例手术死亡和5例非致命性围手术期心肌梗死。晚期随访（术后平均间隔115个月）显示，5年时的精算生存率为94%，10年时为85%。15例晚期死亡、23例非致命性心肌梗死、13例再次手术以及10例患者出现严重心绞痛复发被视为晚期临床事件。术后5年无早期或晚期临床事件的精算生存率为77%，术后10年为53%。对临床、血管造影和手术变量影响生存及无事件生存情况的检测表明，多支血管病变和左心室功能受损会降低生存率；冠心病家族史和吸烟会降低无事件生存率。糖尿病和血清胆固醇升高会降低生存率和无事件生存率。术后心脏导管检查（64例患者，术后平均间隔47个月）显示，乳内动脉移植血管通畅率（27例中的25例，93%）超过静脉移植血管通畅率（88例中的49例，56%，p<0.01）。年轻人的动脉粥样硬化素质可能会影响手术结果，而使用乳内动脉移植血管可能会提高搭桥手术的缓解效果。
