Phillips H R, Johnson R A, Hindman M A, Wagner G S, Harris P J, Dinsmore R E, Gold H K, Leinbach R C, Hutter A M, Erdmann A J, Daggett W M, Buckley M J
Br Heart J. 1981 May;45(5):549-54. doi: 10.1136/hrt.45.5.549.
Three-hundred and thirty-five patients without left main stenosis or recent acute myocardial infarction underwent isolated aortocoronary bypass grafting during 1974 and 1975. The hospital mortality was 2 per cent for the four-year predicted survival is 94 per cent. Neither the preoperative presence or absence of a progressive or unstable angina pattern, the extent of coronary artery disease, nor the left ventricular ejection fraction predicted postoperative survival. None of the 25 patients whose ejection fraction was 0.30 or less died in the perioperative period, and no late deaths occurred in this subgroup until after 36 months of follow-up, giving a predicted four-year survival rate of 82 per cent. With only one exception, patients in this subgroup were operated on because of angina, which was unstable in three-quarters of them. We believe that this study shows that patients with a severely reduced ejection fraction should not be refused aortocoronary bypass grafting if symptoms of angina are severe and predominate over symptoms of heart failure.
1974年至1975年间，335例无左主干狭窄或近期急性心肌梗死的患者接受了单纯主动脉冠状动脉搭桥术。医院死亡率为2%，四年预测生存率为94%。术前是否存在进行性或不稳定型心绞痛模式、冠状动脉疾病的程度以及左心室射血分数均不能预测术后生存率。射血分数为0.30或更低的25例患者中，无一例在围手术期死亡，该亚组在36个月随访前无晚期死亡发生，四年预测生存率为82%。除1例例外，该亚组患者均因心绞痛接受手术，其中四分之三为不稳定型心绞痛。我们认为，这项研究表明，如果心绞痛症状严重且超过心力衰竭症状，射血分数严重降低的患者不应被拒绝接受主动脉冠状动脉搭桥术。
