Boudoulas H, Sohn Y H, O'Neill W, Brown R, Weissler A M
Cardiology. 1984;71(5):247-54. doi: 10.1159/000173673.
This study was designed to determine whether left ventricular performance measured noninvasively from the systolic time intervals could identify patients in whom coronary bypass surgery may improve survival. 71 patients with two- or three-vessel disease undergoing coronary bypass surgery were compared with 78 matched medically treated patients. All patients had recuperated from myocardial infarction by a mean of 17.6 months when systolic time intervals were performed. Surgical and medical patients were classified preoperatively into those with normal and those with abnormal left ventricular performance by preejection period/left ventricular ejection time (PEP/LVET less than or equal to 0.42 and greater than 0.42, respectively). Survival was analyzed by life table and log-rank test. Cumulative 5-year survival in patients with normal left ventricular performance was not statistically different in surgical and medical groups (96 vs. 93%, respectively). In contrast, cumulative survival in patients with abnormal left ventricular performance was significantly greater in the surgical group when compared to the medical group (84 vs. 62, p less than 0.01). Among the patients with abnormal left ventricular function, the mean PEP/LVET and the average vessel disease were not different in the medical and surgical groups. Multivariate analysis of 17 other clinical and laboratory risk variables were not different between these two groups. It is concluded that coronary bypass surgery my improve survival in patients with two- or three-vessel disease and left ventricular dysfunction.
本研究旨在确定通过收缩期时间间期进行无创测量的左心室功能是否能够识别出冠状动脉搭桥手术可能改善其生存率的患者。将71例接受冠状动脉搭桥手术的双支或三支血管病变患者与78例匹配的接受药物治疗的患者进行比较。在进行收缩期时间间期测量时，所有患者自心肌梗死恢复的平均时间为17.6个月。术前根据射血前期/左心室射血时间（PEP/LVET，分别小于或等于0.42和大于0.42）将手术组和药物治疗组患者分为左心室功能正常和异常两类。通过寿命表和对数秩检验分析生存率。左心室功能正常的患者，手术组和药物治疗组的累积5年生存率无统计学差异（分别为96%和93%）。相比之下，左心室功能异常的患者，手术组的累积生存率显著高于药物治疗组（84%对62%，p<0.01）。在左心室功能异常的患者中，药物治疗组和手术组的平均PEP/LVET以及平均血管病变情况并无差异。对其他17个临床和实验室风险变量进行多变量分析，这两组之间也无差异。结论是，冠状动脉搭桥手术可能改善双支或三支血管病变且左心室功能不全患者的生存率。
