Hosoda Y, Nukariya M, Watanabe M, Sasaguri S, Kazui M, Tahara M, Watanabe T, Sato T, Goto M, Takazawa K
Department of Thoracic Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
Cardiovasc Surg. 1993 Aug;1(4):403-9.
A total of 806 primary coronary artery bypass graft operations were performed between January 1984 and December 1989. Excluding eight hospital deaths (1.0%) and three patients lost in follow-up, a total of 795 patients were contracted, with a follow-up rate of 99.6%. The mean follow-up period was 53.6 months, the longest being 92 months. Of the patients 42 died in late follow-up. Malignant neoplasm was the major cause of death (n = 17, 40% of total late deaths), which far exceeded the number of cardiac deaths (n = 6, 14%). The actuarial survival, excluding the initial hospital deaths, was 95% at 5 years and 91% at 7 years by the Kaplan-Meier method. By multivariate logistic analysis, four clinical variables were identified as significant in influencing the late survival, in the following order: (1) presence or absence of diabetes mellitus (P = 0.00008); (2) age > or = 65 years or < 65 years (P = 0.002); (3) left ventricular function with ejection fraction < 45% or > or = 45% (P = 0.014); and (4) use or non-use of left internal mammary arteries to bypass the left anterior descending artery (P = 0.016). Sex (male versus female), severity of anginal symptoms (mild versus severe) and number of diseased vessels (single and double versus triple vessel and left main trunk disease) did not significantly influence the late survival of the patients.
1984年1月至1989年12月期间，共进行了806例原发性冠状动脉旁路移植手术。排除8例医院死亡病例（1.0%）和3例失访患者，共纳入795例患者，随访率为99.6%。平均随访期为53.6个月，最长为92个月。在随访后期，42例患者死亡。恶性肿瘤是主要死因（n = 17，占晚期死亡总数的40%），远远超过心脏死亡病例数（n = 6，14%）。采用Kaplan-Meier法，排除最初的医院死亡病例后，5年精算生存率为95%，7年为91%。通过多因素逻辑分析，确定了四个对晚期生存有显著影响的临床变量，顺序如下：（1）是否患有糖尿病（P = 0.00008）；（2）年龄≥65岁或＜65岁（P = 0.002）；（3）左心室射血分数＜45%或≥45%（P = 0.014）；（4）是否使用左乳内动脉绕过左前降支（P = 0.016）。性别（男性与女性）、心绞痛症状严重程度（轻度与重度）以及病变血管数量（单支和双支与三支血管及左主干病变）对患者的晚期生存没有显著影响。
