| Autor: |
Hanson, Eric C., Levine, Frederick H., Scott Adzick, N., Lees, Robert S., Daggett, Willard M., Gerald Austen, W., Buckley, Mortimer J. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; March 1980, Vol. 79 Issue: 3 p372-380, 9p |
| Abstrakt: |
Hyperlipoproteinemia is a known risk factor for the development of coronary artery disease. To assess the perioperative and late results of myocardial revascularization for angina pectoris in patients with hyperlipoproteinemia, we reviewed the records of 200 patients (age range 24 to 75 years). Preoperatively the average New York Heart Association (N.Y.H.A.) angina class was 3.1 ± 0.7. One hundred three patients (51.5%) had type 11 disease, 95 patients (47.5%) type IV, and two (1%) had type III or V disease. The mean age of the patients with type II disease was 3 years less than that of patients with type IV disease (50 versus 53 years, p < 0.05). When compared with subjects with type IV disease, those with type II disease were shown by angiography to have a significantly higher incidence of left main coronary artery stenosis (28% versus 6%), a greater average number of proximal coronary artery lesions per patient (2.8 ± 0.9 versus 2.4 ± 0.7), and more frequent atheromatous disease in distal coronary artery segments (74% versus 49%) (all p <0.01). The operative mortality rate of coronary revascularization was 6% (12/200), including nine patients with type II disease (9.5%) and three with type IV disease (2.9%). All deaths occurred in patients with three- and four-vessel coronary artery disease. Seven (58%) of these 12 patients had left main coronary artery disease and 10 (83%) had significant distal lesions. The nonfatal perioperative infarct rate was 4%. At a mean follow-up period of 33 months (range 10 to 90 months), there have been four late deaths (2.2%), including three patients with type II disease (3.5%) and one with type IV disease (1.0%). There have been nine late nonfatal myocardial infarctions (4.9%). One hundred thirty-nine patients (73%) have had complete relief of angina and 34 (19%) have had substantial improvement. The average postoperative N.Y.H.A. class was similar for the two groups (1.6 ±0.7). Myocardial revascularization can be accomplished with acceptable risk and excellent long-term results in patients with hyperlipoproteinemia. However, patients with type II disease have higher hospital and late mortality rates. These findings are consistent with the known increased prevalence of left main coronary stenosis and diffuse distal coronary artery disease in patients with this type of hyperlipidemia. |
| Databáze: |
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