van Brussel B L, Plokker H W, Ernst S M, Ernst N M, Knaepen P J, Koomen E M, Tijssen J G, Vermeulen F E, Voors A A
St Joseph Hospital, Veghel, The Netherlands.
Circulation. 1993 Nov;88(5 Pt 2):II87-92.
Although the long-term results of isolated venous coronary artery bypass surgery are well known, there are few multivariate statistical data on such patient groups.
We report on 428 consecutive patients, 383 men and 45 women with a mean age of 52.6 years, who underwent isolated venous aortocoronary bypass graft surgery with or without left ventricular aneurysm surgery between April 1, 1976, and April 1, 1977, and whom we followed prospectively. A multivariate analysis using the Cox regression model was performed to establish the determinants of long-term outcome. The hospital mortality and myocardial infarction rates were 3% and 6.3%, respectively. Complete revascularization was obtained in 77.6%. Follow-up was 99.8% complete and averaged 13.4 years (range, 1.5 months to 16.6 years). Actuarial survival after 5, 10, and 15 years is 94.2%, 82.4%, and 63%, respectively. The cumulative probability of event-free survival for cardiac death, acute myocardial infarction, reintervention, and angina pectoris at 5, 10, and 15 years, respectively, are 97.8%, 90.1%, 74.4%; 98.5%, 89.0%, 77.4%; 97.0%, 83.0%, 62.1%; and 77.8%, 52.1%, 26.8%. Left ventricular function and the number of vessels diseased are the independent preprocedural predictors of cardiac survival. Obesity and hypertriglyceridemia are preprocedural predictors of late myocardial infarction. Preoperative validity (Canadian Cardiovascular Society) and the number of diseased vessels are the predictors of recurrent angina.
We conclude that the long-term results of isolated venous bypass graft surgery are dependent not only on well-known preprocedural factors such as number of vessels diseased, left ventricular function, and age but also on obesity and hypertriglyceridemia.
尽管单纯静脉冠状动脉搭桥手术的长期结果已为人熟知，但关于此类患者群体的多变量统计数据却很少。
我们报告了428例连续患者，其中383例男性和45例女性，平均年龄52.6岁，他们于1976年4月1日至1977年4月1日期间接受了单纯静脉主动脉冠状动脉搭桥移植手术，部分患者还接受了左心室动脉瘤手术，并对其进行了前瞻性随访。使用Cox回归模型进行多变量分析以确定长期预后的决定因素。医院死亡率和心肌梗死发生率分别为3%和6.3%。77.6%的患者实现了完全血运重建。随访完成率为99.8%，平均随访时间为13.4年（范围为1.5个月至16.6年）。5年、10年和15年的精算生存率分别为94.2%、82.4%和63%。心脏死亡、急性心肌梗死、再次干预和心绞痛的无事件生存累积概率在5年、10年和15年时分别为97.8%、90.1%、74.4%；98.5%、89.0%、77.4%；97.0%、83.0%、62.1%；以及77.8%、52.1%、26.8%。左心室功能和病变血管数量是术前心脏生存的独立预测因素。肥胖和高甘油三酯血症是晚期心肌梗死的术前预测因素。术前有效性（加拿大心血管学会分级）和病变血管数量是复发性心绞痛的预测因素。
我们得出结论，单纯静脉搭桥移植手术的长期结果不仅取决于病变血管数量、左心室功能和年龄等众所周知的术前因素，还取决于肥胖和高甘油三酯血症。
