Jones E L, Waites T F, Craver J M, Bone D K, Hatcher C R, Thompkins T
Ann Thorac Surg. 1982 Oct;34(4):427-34. doi: 10.1016/s0003-4975(10)61405-1.
Seventy-eight patients having prolonged pain (greater than 20 minutes) with transient S-T segment and T-wave changes and coronary artery bypass were compared to 288 patients previously reported in the National Cooperative Study on the treatment of unstable angina pectoris. Clinical characteristics observed in the present study that differed from those of the National Cooperative Study included a more chronic anginal pattern, slightly older age, greater number of women, and higher incidence of prior myocardial infarction. The severity of vessel disease was the same for both groups. Left ventricular function was slightly better in the present series. The incidence of perioperative infarction in the present series (3.8%) was significantly less than that for surgical patients reported in the National Cooperative Study (17%). Hospital mortality was also less: 1.2% versus 2.0 and 3.0% for the medical and surgical patients, respectively, in the National Cooperative Study. Late myocardial infarction was 11% and 13% at 30 months for medical and surgical patients in the National Cooperative Study, and only 3% at 43 months in the present surgical series. Actuarial survival for the entire patient population was 95% at 42 months. The reduced hospital mortality and perioperative infarction rates were attributed to immediate operation once acute myocardial infarction has been ruled out, advances in surgical and anesthetic technique, selection of patients with preserved left ventricular function, and a trend toward complete revascularization.
78例患有持续性疼痛（超过20分钟）且伴有短暂性S-T段和T波改变并接受冠状动脉搭桥手术的患者与先前在全国不稳定型心绞痛治疗合作研究中报告的288例患者进行了比较。本研究中观察到的与全国合作研究不同的临床特征包括更慢性的心绞痛模式、年龄稍大、女性数量更多以及既往心肌梗死发生率更高。两组的血管疾病严重程度相同。本系列患者的左心室功能稍好。本系列患者围手术期梗死发生率（3.8%）明显低于全国合作研究中报告的手术患者（17%）。医院死亡率也较低：全国合作研究中内科和外科患者的医院死亡率分别为2.0%和3.0%，而本研究中为1.2%。全国合作研究中内科和外科患者在30个月时晚期心肌梗死发生率分别为11%和13%，而本手术系列在43个月时仅为3%。整个患者群体在42个月时的精算生存率为95%。医院死亡率和围手术期梗死率降低归因于一旦排除急性心肌梗死即立即进行手术、手术和麻醉技术的进步、选择左心室功能保留的患者以及完全血运重建的趋势。
