冠状动脉手术研究（CASS）登记中接受药物治疗患者的生存率。

Survival of medically treated patients in the coronary artery surgery study (CASS) registry.

作者信息

Mock M B, Ringqvist I, Fisher L D, Davis K B, Chaitman B R, Kouchoukos N T, Kaiser G C, Alderman E, Ryan T J, Russell R O, Mullin S, Fray D, Killip T

出版信息

Circulation. 1982 Sep;66(3):562-8. doi: 10.1161/01.cir.66.3.562.

DOI:10.1161/01.cir.66.3.562

PMID:6980062

Abstract

The objective of this study was to evaluate the impact on survival of the anatomic extent of obstructive coronary artery disease and of two measures of left ventricular (LV) performance. This study is based on 20,088 patients without previous coronary artery bypass graft surgery who were enrolled in the registry of the National Heart, Lung, and Blood Institute Coronary Artery Surgery Study from 1975 to 1979. The cumulative 4-year survival of medically managed patients was analyzed to determine the survival of specific subsets of patients with obstructive coronary disease. The vital status of 99.8% of the patients was known. The 4-year survival of medically treated patients with no significant obstructive disease was 97%, in contrast to 92%, 84% and 68% in patients with one-, two- and three-vessel disease, respectively. The presence of left main coronary artery disease decreased survival significantly. The 4-year survival decreased from 70% to 60% in patients with three-vessel disease when significant obstruction of the left main coronary artery was also present. Patients with significant coronary artery disease who had an ejection fraction of 50--100%, 35--49%, and 0--34% had a 4-year survival of 92%, 83% and 58%, respectively. The systolic contraction pattern was assessed in five selected segments and given a score of 1--6, with a score of 1 for normal function, increasing to 6 if an aneurysm was present. In a patient with normal LV contraction in all five segments of the LV ventricular angiogram, the LV score would equal 5. Patients with an LV score of 5--11, 12--16 and 17--30 had 4-year survivals of 90%, 71% and 53%, respectively. Patients with good LV function (a score of 5--11) had a 4-year survival of 94%, 91% and 79% for one-, two- and three-vessel disease, respectively. Patients with poor left ventricular function (score of 17--30) had a 4-year survival rate of 67%, 61% and 42% in one-, two- and three-vessel disease, respectively. Thus, LV function is a more important predictor of survival than the number of diseased vessels.

摘要

本研究的目的是评估阻塞性冠状动脉疾病的解剖范围以及两种左心室（LV）功能指标对生存率的影响。本研究基于20088例未曾接受过冠状动脉搭桥手术的患者，这些患者入选了1975年至1979年美国国立心肺血液研究所冠状动脉外科研究登记处。分析药物治疗患者的累积4年生存率，以确定阻塞性冠状动脉疾病特定亚组患者的生存率。已知99.8%患者的生命状态。无明显阻塞性疾病的药物治疗患者4年生存率为97%，而单支血管病变、双支血管病变和三支血管病变患者的4年生存率分别为92%、84%和68%。左主干冠状动脉疾病的存在显著降低了生存率。当左主干冠状动脉也存在明显阻塞时，三支血管病变患者的4年生存率从70%降至60%。射血分数为50 - 100%、35 - 49%和0 - 34%的显著冠状动脉疾病患者4年生存率分别为92%、83%和58%。在五个选定节段评估收缩期收缩模式，并给予1 - 6分，正常功能为1分，若存在动脉瘤则增至6分。在左心室血管造影所有五个节段左心室收缩正常的患者中，左心室评分为5分。左心室评分为5 - 11分、12 - 16分和17 - 30分的患者4年生存率分别为90%、71%和53%。左心室功能良好（评分为5 - 11分）的患者，单支血管病变、双支血管病变和三支血管病变的4年生存率分别为94%、91%和79%。左心室功能差（评分为17 - 30分）的患者，单支血管病变、双支血管病变和三支血管病变的4年生存率分别为67%、61%和42%。因此，左心室功能比病变血管数量更能预测生存率。