Kent K M, Rosing D R, Ewels C J, Lipson L, Bonow R, Epstein S E
Am J Cardiol. 1982 Jun;49(8):1823-31. doi: 10.1016/0002-9149(82)90198-9.
One hundred forty-seven asymptomatic or mildly symptomatic patients with coronary artery disease, who did not have significant left main coronary occlusion and had an ejection fraction greater than 20 percent, were followed up prospectively for 6 to 67 months (average 25). Significant obstruction of one coronary artery was present in 28 percent of patients, of two coronary arteries in 31 percent and of three coronary arteries in 41 percent. Ejection fraction was 55 percent or greater in 69 percent of patients. During the follow-up there were eight deaths (annual mortality rate 3 percent for the entire group, 1.5 percent for patients with single and double vessel disease but 6 percent for those with triple vessel disease). Better definition of high and low risk subgroups of patients with three vessel disease was accomplished with exercise testing. Despite a history of mild symptoms, 25 percent of the patients with triple vessel disease exhibited poor exercise capacity on exercise testing after administration of beta adrenoceptor blocking agents and nitrates was discontinued; of these, 40 percent either died (20 percent) or had progressive symptoms requiring operation (20 percent) (annual mortality rate 9 percent). Of the patients with good exercise capacity, only 22 percent either died (7 percent) or had progressive symptoms (15 percent) (annual mortality rate 4 percent). Thus, prognosis is excellent in patients with no or mild symptoms who have one or two vessel coronary disease. Patients with three vessel disease who have good exercise capacity documented by objective testing have an annual mortality rate of 4 percent. However, because patients with three vessel disease and poor exercise capacity have an extremely grave prognosis, it would appear reasonable to recommend coronary bypass surgery for this subgroup, even in the absence of supporting data derived from a definitive randomized study.
147例无症状或症状轻微的冠心病患者，无明显左主干冠状动脉闭塞且射血分数大于20%，进行了6至67个月（平均25个月）的前瞻性随访。28%的患者存在一支冠状动脉严重阻塞，31%的患者存在两支冠状动脉严重阻塞，41%的患者存在三支冠状动脉严重阻塞。69%的患者射血分数为55%或更高。随访期间有8例死亡（全组年死亡率3%，单支和双支血管病变患者为1.5%，但三支血管病变患者为6%）。通过运动试验对三支血管病变患者的高危和低危亚组进行了更好的界定。尽管有轻微症状史，但在停用β肾上腺素能阻滞剂和硝酸盐后，25%的三支血管病变患者运动试验显示运动能力较差；其中，40%的患者死亡（20%）或出现需要手术的进行性症状（20%）（年死亡率9%）。运动能力良好的患者中，只有22%的患者死亡（7%）或出现进行性症状（15%）（年死亡率4%）。因此，有单支或双支血管冠心病且无症状或症状轻微的患者预后极佳。经客观测试证明运动能力良好的三支血管病变患者年死亡率为4%。然而，由于三支血管病变且运动能力差的患者预后极差，即使缺乏来自确定性随机研究的支持数据，对该亚组患者推荐冠状动脉搭桥手术似乎也是合理的。
