Beatt K J, Fath-Ordoubadi F, Huehns T
Academic Unit of Cardiovascular Medicine, Charing Cross and Westminster Medical School, London, UK.
Int J Card Imaging. 1993;9 Suppl 1:77-83. doi: 10.1007/BF01143149.
There remains a need to establish adequate protocols for investigating the short- and long-term follow-up of revascularization procedures. For coronary angioplasty the most reliable basis for decision-making in managing patients is the symptomatology of the patient. For bypass surgery a protocol should be established to evaluate patients late, at 5 to 10 years following bypass surgery, in particular those with saphenous vein grafting, as graft and patient survival begins to fall after this period. Investigation after this may be too late for many patients who may already have several occluded grafts and poor left ventricular function, two of the most important prognostic factors post bypass surgery. The improvement and refinement of non-invasive investigations has led to a better understanding of the value and limitations of many of these tests, but it is particularly important that the limitations of many investigation are fully appreciated when they are used to influence clinical decisions. In this regard, a study comparing and integrating the predictive value of the persistence or return to symptoms, a positive non-invasive test, and a positive invasive test would surely prove invaluable.
仍有必要建立适当的方案来调查血管重建手术的短期和长期随访情况。对于冠状动脉血管成形术，管理患者时最可靠的决策依据是患者的症状。对于搭桥手术，应制定一个方案，以便在搭桥手术后5至10年对患者进行晚期评估，尤其是那些接受大隐静脉移植的患者，因为在此之后移植血管和患者的生存率开始下降。在此之后进行调查，对于许多可能已经有多处移植血管闭塞和左心室功能不佳的患者来说可能为时已晚，而这两个因素是搭桥手术后最重要的预后因素。非侵入性检查的改进和完善使得人们对许多此类检查的价值和局限性有了更好的理解，但当这些检查被用于影响临床决策时，充分认识到许多检查的局限性尤为重要。在这方面，一项比较和整合症状持续或复发、非侵入性检查阳性和侵入性检查阳性的预测价值的研究肯定会被证明是非常有价值的。
