Kennedy J W, Kaiser G C, Fisher L D, Fritz J K, Myers W, Mudd J G, Ryan T J
Circulation. 1981 Apr;63(4):793-802. doi: 10.1161/01.cir.63.4.793.
Fifteen institutions participating in the Collaborative Study in Coronary Artery Surgery (CASS) have performed isolated coronary artery bypass surgery upon 6630 patients (1061 women and 5569 men) for coronary artery disease. The overall operative mortality (OM) was 2.3% (range 0.3-6.4%). Mortality increased with age, from 0 in the group 20-29 years old to 7.9% in the group 70 years and older. OM was higher for women in each group, ranging from 2.8% for ages 30-39 years to 12.3% for age 70 years and older (0.8% and 5.8% for men). Clinical manifestations of congestive heart failure were associated with increased OM. Mortality was 1.4% in one-vessel, 2.1% in two-vessel and 2.8% in three-vessel disease (diameter narrowing greater than or equal to 70%). Among 1019 patients with left main coronary artery (LMCA) stenosis, OM ranged from 1.6% in patients with mild stenosis and a right-dominant system to 25% in patients with severe (greater than or equal to 90%) stenosis and left dominance. OM varied with ejection fraction (EF) (1.9% for EF greater than or equal to 50% to 6.7% for EF less than 19%) and left ventricular wall motion score (1.7% for least abnormal to 9.1% for most abnormal). For elective surgery, OM was 1.7%, for urgent surgery 3.5%, and for emergency surgery 10.8%. Mortality was 40.0% among 30 patients with severe LMCA stenosis who underwent emergency revascularization. Advanced age, female sex, symptoms of heart failure, LMCA stenosis, impaired left ventricular function and nonelective surgery are associated with a higher OM. These factors should be considered in the selection of patients for coronary artery surgery.
参与冠状动脉手术协作研究（CASS）的15家机构已对6630例冠心病患者（1061例女性和5569例男性）进行了单纯冠状动脉搭桥手术。总体手术死亡率（OM）为2.3%（范围0.3 - 6.4%）。死亡率随年龄增加，从20 - 29岁组的0%增至70岁及以上组的7.9%。每组女性的OM更高，从30 - 39岁组的2.8%到70岁及以上组的12.3%（男性为0.8%和5.8%）。充血性心力衰竭的临床表现与OM增加相关。单支血管病变患者的死亡率为1.4%，双支血管病变患者为2.1%，三支血管病变患者（直径狭窄大于或等于70%）为2.8%。在1019例左主干冠状动脉（LMCA）狭窄患者中，OM范围从轻度狭窄且为右优势系统患者的1.6%到重度（大于或等于90%）狭窄且为左优势系统患者的25%。OM随射血分数（EF）而变化（EF大于或等于50%时为1.9%，EF小于19%时为6.7%）以及左心室壁运动评分（最正常时为1.7%，最异常时为9.1%）。择期手术的OM为1.7%，急诊手术为3.5%，紧急手术为10.8%。30例接受紧急血运重建的重度LMCA狭窄患者的死亡率为40.0%。高龄、女性、心力衰竭症状、LMCA狭窄、左心室功能受损和非择期手术与较高的OM相关。在选择冠状动脉手术患者时应考虑这些因素。
