Crenshaw J H, el-Zeky F, Vander Zwaag R, Sullivan J M, Ramanathan K B, Mirvis D M
Department of Medicine, University of Tennessee, Memphis 38163, USA.
Am J Med Sci. 1995 Jul;310(1):7-13. doi: 10.1097/00000441-199507000-00005.
This study was designed to determine the impact of noncritical (less than 70% narrowing of the luminal diameter) coronary stenoses on the long-term survival rate of patients with coronary artery disease. The survival rate of 3,342 patients with normal coronary arteries (Group 1A) was compared with that of 2,184 patients with only noncritical stenoses (Group 1B). Similarly, the survival rate of 1,128 patients with one or more critical lesions (Group 2A) was compared with that of 5,944 cases with noncritical plus critical lesions (Group 2B). Patients with noncritical lesions had significantly lower 10-year survival rates (85.8%) than did those with normal coronary arteries (90.1%). However, the difference in survival rate was attributable to older age, male sex, and higher prevalence of cigarette smoking, diabetes mellitus, and hypertension in Group 1B than in Group 1A; presence of noncritical stenoses was not a statistically significant independent determinant of survival. Long-term survival rates of the patients with one or more critical lesions (Group 2A) were equivalent to that of patients with critical stenoses plus one or more noncritical lesions (Group 2B). Therefore, 1) patients with only noncritical stenoses have more risk factors for coronary artery disease than do those with normal coronary arteries; 2) these patients have a reduced long-term survival rate that reflects these risk factors rather than the presence of noncritical lesions; and 3) in patients with critical lesions, the presence of additional non-critical stenoses does not affect the long-term survival rate.
本研究旨在确定非临界性（管腔直径狭窄小于70%）冠状动脉狭窄对冠心病患者长期生存率的影响。将3342例冠状动脉正常患者（1A组）的生存率与2184例仅存在非临界性狭窄患者（1B组）的生存率进行比较。同样，将1128例有一处或多处临界性病变患者（2A组）的生存率与5944例有非临界性病变加临界性病变患者（2B组）的生存率进行比较。存在非临界性病变的患者10年生存率（85.8%）显著低于冠状动脉正常的患者（90.1%）。然而，生存率的差异归因于1B组患者年龄较大、男性比例较高、吸烟、糖尿病和高血压的患病率高于1A组；非临界性狭窄的存在并非生存的统计学显著独立决定因素。有一处或多处临界性病变患者（2A组）的长期生存率与有临界性狭窄加一处或多处非临界性病变患者（2B组）的长期生存率相当。因此，1）仅存在非临界性狭窄的患者比冠状动脉正常的患者有更多的冠心病危险因素；2）这些患者长期生存率降低反映了这些危险因素而非非临界性病变的存在；3）对于有临界性病变的患者，额外非临界性狭窄的存在不影响长期生存率。
