Cosgrove D M, Loop F D, Lytle B W, Baillot R, Gill C C, Golding L A, Taylor P C, Goormastic M
J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):673-84.
From 1970 to 1982, 24,672 patients underwent primary isolated myocardial revascularization: Group I, 4,517 patients operated upon from 1970 to 1973; Group II, 6,181 patients from 1974 to 1976; Group III, 6,869 patients from 1977 to 1979; and Group IV, 7,105 patients from 1980 to 1982. Operative mortality was 1.2% for the entire experience and 1.2%, 1.4%, 1.6%, and 0.8% for Groups I to IV, respectively. Mortality for Group IV was significantly lower (p less than 0.001). In decreasing order of significance, the risk factors were emergency operation, congestive heart failure, left main disease, female gender, history of congestive heart failure, advancing age, normothermic arrest, number of grafts, poor ventricular function, and incomplete revascularization. The same analysis of Groups I to IV demonstrated that advanced age, emergency operation, female gender, and congestive heart failure persisted as risk factors while incomplete revascularization and abnormal electrocardiogram emerged as new risk factors. Cardiac causes accounted for 203 (66.2%) patient deaths. This gradually decreased from 75.3% in Group II to 58.5% in Group IV. Neurological deficit was the second most frequent cause of death, 29 (9.6%), reaching a high in Group IV (18.9%). We conclude that (1) morbidity and mortality have decreased significantly despite increasing risk factors; (2) congestive heart failure has replaced emergency operation as the principal risk factor; (3) left main disease, number of grafts, and poor ventricular function have been neutralized as risk factors; and (4) cardiac causes of death are decreasing and being replaced by other system failure.
1970年至1982年期间，24672例患者接受了初次单纯心肌血运重建术：第一组，1970年至1973年接受手术的4517例患者；第二组，1974年至1976年的6181例患者；第三组，1977年至1979年的6869例患者；第四组，1980年至1982年的7105例患者。整个研究中的手术死亡率为1.2%，第一组至第四组分别为1.2%、1.4%、1.6%和0.8%。第四组的死亡率显著更低（p小于0.001）。按显著性递减顺序排列，危险因素依次为急诊手术、充血性心力衰竭、左主干病变、女性、充血性心力衰竭病史、年龄增长、常温停循环、移植血管数量、心室功能差以及血运重建不完全。对第一组至第四组进行的相同分析表明，高龄、急诊手术、女性和充血性心力衰竭仍是危险因素，而血运重建不完全和心电图异常成为新的危险因素。心脏原因导致203例（66.2%）患者死亡。这一比例从第二组的75.3%逐渐降至第四组的58.5%。神经功能缺损是第二常见的死亡原因，有29例（9.6%），在第四组达到最高（18.9%）。我们得出结论：（1）尽管危险因素增加，但发病率和死亡率已显著降低；（2）充血性心力衰竭已取代急诊手术成为主要危险因素；（3）左主干病变、移植血管数量和心室功能差已不再是危险因素；（4）心脏原因导致的死亡正在减少，并被其他系统衰竭所取代。
