Whalen R E, Harrell F E, Lee K L, Rosati R A
Circulation. 1982 Jun;65(7 Pt 2):49-52. doi: 10.1161/01.cir.65.7.49.
We evaluated the survival rates of medically and surgically treated patients with one-, two- or three-vessel coronary disease (CAD), stable pain, and normal left ventricular function observed at the Duke University Medical Center over an 11-year period. There was no statistical difference in survival when medical and surgical treatment were compared in patients with one-, two- or three-vessel disease (greater than or equal to 75% vessel occlusion). However, the survival curve of patients with three-vessel disease treated surgically consistently exceeded that of those treated medically over a 7-year follow-up period. This difference was not statistically significant, but suggests the need for further study in this group. When patients with 50% or greater lesions in three vessels, stable angina and normal left ventricular function were evaluated, surgical survival was greater than medical survival, although the difference is not statistically significant. The survival in the Duke medical group is substantially higher than that reported for medical patients in the European Cooperative Trial, which suggests that the significant differences surgical in survival in the European Cooperative Trial were largely due to a lower medical survival than that in the Duke medical group.
我们评估了在杜克大学医学中心观察到的11年间患有单支、双支或三支血管冠状动脉疾病(CAD)、稳定型心绞痛且左心室功能正常的患者,接受药物治疗和手术治疗后的生存率。在单支、双支或三支血管疾病(血管闭塞大于或等于75%)患者中,比较药物治疗和手术治疗时,生存率没有统计学差异。然而,在7年的随访期内,接受手术治疗的三支血管疾病患者的生存曲线始终超过接受药物治疗的患者。这种差异没有统计学意义,但表明需要对该组患者进行进一步研究。当评估三支血管病变达50%或更高、稳定型心绞痛且左心室功能正常的患者时,手术治疗的生存率高于药物治疗,尽管差异没有统计学意义。杜克大学医学组的生存率显著高于欧洲合作试验中报告的接受药物治疗患者的生存率,这表明欧洲合作试验中手术治疗在生存率方面的显著差异很大程度上是由于药物治疗的生存率低于杜克大学医学组。