관상동맥 우회술의 장기 생존율 = Long-term Survival after Coronary Artery bypass Surgery

국문 초록 (Abstract)

배경: 관상동맥 우회술 후 장기 생존율에 대한 우리의 보고는 많지 않다. 이 연구는 관상동맥 우회술 시작 초기에 수술 받은 환자들의 장기 생존율을 알아보았다. 대상 및 방법: 1990년 12월부터 1995년 12월까지 관상동맥 우회술을 받은 114예(남 79예, 여 35예; 평균연령 58.4세)를 대상으로 하였다. 대부분의 환자가 체외순환 하에 좌측 속가슴동맥과 하지 복재정맥으로 우회로술을 받았고 대동맥 차단 상태에서 근위부 및 원위부 문합을 시행하였다. 결과: 평균 135.5 17.9개월의 추적 기간 동안 모두 37예(32.5%)가 사망하였으며, 사망자 중 심장사망은 10예(27%)뿐이었다. 수술 후 전체 사망에 대한 1년, 5년, 10년, 13년의 생존율은 각각 95.6%, 85.1%, 71.8%, 57.9%였고, 심장사망에 대한 1년, 5년, 10년, 13년의 생존율은 각각 97.4%, 94.5%, 92.1%, 81.3%였으며, 장기 생존율에 대한 예상인자로는 성별 및 연령이었다. 수술 후 관상동맥 조영술 및 중재술의 예상인자는 수술 전의 고혈압, 당뇨병, 고지혈증 등이었다. 결론: 초기의 관상동맥 우회술 후 장기생존율은 다른 보고와 비슷하였으며, 여성에서 장기생존율이 우수하였고 수술 전 고지혈증을 가진 환자에서 수술 후 관상동맥 중재술이 더 많았다.

다국어 초록 (Multilingual Abstract)

Background: There were very few reports on long-term survival after coronary artery bypass graft (CABG) in this country. The aim of this study is to investigate the long-term result in patients undergoing CABG in the early period in this hospital. Material and Method: One-hundred and fourteen patients (male/female, 79/35) who had undergone CABG from December 1990 to December 1995 were identified. Most of the patients had undergone CABG using left internal thoracic artery and vein grafts under cardiopulmonary bypass and cardioplegic arrest, and the proximal and distal anastomoses of the grafts were performed during the single aortic cross clamping period. Result: During the mean follow-up period of 135.5±17.9 months, 37 patients (32.5%) were dead and only 10 patients (27%) of them died of cardiac cause. Risk-unadjusted survival after CABG was 95.6%, 85.1%, 71.8%, and 57.9% at 1, 5, 10, and 13 years, respectively, and cardiac death-free survival was 97.4%, 94.5%, 92.1%, and 81.3% at 1, 5, 10, and 13 years, respectively. Predictable factors of long-term survival were sex and age. Predictable factors of postoperative coronary angiography and intervention were hypertension, diabetes, and dyslipidemia. Conclusion: Long-term survival after CABG in the early operative period was comparable to the previous outcomes, and females showed the better long-term survival. Postoperative coronary intervention was more common in patients with preoperative dyslipidemia.

참고문헌 (Reference)

• 1 "Validation and interdependence with patient- variables of the influence of procedural variables on early and late survival after CABG" 12 : 1-19, 1997
• 2 "The clinical experience and long-term results with 369 cases of coronary artery bypass graft suegery" 28 : 583-90, 1995
• 3 "Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting:effects on mortality and event-free survival" 127 : 1408-15, 2004
• 4 "Is return of angina after coronary artery bypass grafting immutable" 440-53, jthoraccardiovascsurg1998
• 5 "Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting" 67 : 1045-52, 1999
• 6 "First cardiological or cardiosurgical reintervention for ischemic heart diseaseafter primary coronary artery bypass grafting" 14 : 480-7, 1998
• 7 "Effect of diabetes and associated conditions on long-term survival after coronary artery bypass graft surgery" 110 : 11-1 4, 2004
• 8 "Does arterial revascularization decrease the risk of infarction after coronary artery bypass grafting" 66 : 1-10, 1998
• 9 "Differences between men and women in compliance with risk factor reduction before and after coronary artery bypass surgery" 19 : 73-7 9, 2001
• 10 "Coronary artery surgery:the end of the beginning" 14 : 554-71, 1998
• 11 "Coronary artery bypass grafting in patients with advanced left ventricular dysfunction" 66 : 1632-9, 1998
• 12 "Comparison of long- term clinical results of double versus single internal mammary artery bypass grafting" 67 : 466-70, 1999
• 13 "Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up" 107 : 657-62, 1994
• 14 "Cause of death in clinical research time for a reassessment" 618-20, 1999
• 15 "CASS Registry long term surgical survival" 33 : 488-98, 1999
• 16 "An invitation to obfuscation" Incorrect death certification 81 : 245 253-7 4, 1987
• 17 "Accuracy of death certificates for coding coronary heart disease as the cause of death" 129 : 1020-6, 1998
• 18 "ACC/AHA Guidelines for coronary artery bypass graft surgery A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery American College of Cardiology/American Heart Association" 1262-347, 1999