The place of coronary artery bypass surgery: an appraisal

The enthusiasm for performing coronary artery bypass graft (CABG) surgery in Australia is increasing. The results of a number of careful trials which have compared surgical with medical treatment have now appeared. While there is agreement on both the increased survival provided by CABG surgery in those with left main coronary artery stenosis and the relief of symptoms in patients in whom medical therapy has failed to control severe angina, there is debate about the value of surgery in other types of disease. With improvements in medical therapy, the most recent trials have failed to show a significant overall survival benefit from surgery, although it is generally considered that surgery can relieve angina and that, in at least some groups of persons with stenosis of all three main coronary vessels (triple-vessel disease), surgery may prolong life. Alternative methods of prolonging survival among people with ischaemic heart disease include the reduction of risk factors (such as hypertension, raised blood cholesterol levels and cigarette smoking), as well as treating patients with beta-blocking agents after a myocardial infarction. We suggest it is likely that a combination of these approaches could be more effective in terms of lives saved than is CABG and may be less expensive. The current expansion of CABG surgery in Australia should be viewed in this light.     

Does coronary surgery prolong life in comparison with medical management?

This analysis attempts to utilize natural history controls to answer the question as to whether coronary surgery prolongs life in comparison to medical management. Selected natural history studies are compared and contrasted in an effort to obtain an average survival curve for patients with coronary artery disease comparable to those presently being operated. The Duke University Medical Center series of concurrent operated and non-operated patients is reviewed to demonstrate the difference of prognosis of patients with coronary artery disease and the complexities involved in answering the question. It is concluded that, on average, coronary surgery does not prolong life in comparison to medical management over the span of 2-5 years. There may be certain higher risk patients whose lives may be prolonged by aortocoronary bypass surgery but more patients and more prolonged follow-up are needed fully to answer the question.     

In-hospital and long-term mortality in male veterans following noncardiac surgery. The Study of Perioperative Ischemia Research Group.

OBJECTIVES--To determine the causes of and risk factors for mortality following noncardiac surgery. DESIGN--Prospective cohort study. SETTING--A university-affiliated Veterans Affairs medical center. PATIENTS--Consecutive series of 474 men between the ages of 38 and 89 years (mean age, 68 years) who were undergoing major noncardiac surgery involving general anesthesia. All subjects had known coronary artery disease or were at high risk for coronary artery disease. MEASUREMENTS AND RESULTS--During the initial hospitalization, 26 patients (5%) died, most commonly from sepsis (n = 6) or cardiac diseases (n = 6). Deaths occurred from postoperative days 2 to 69; half occurred more than 3 weeks after surgery. Multivariable analysis disclosed that a history of hypertension (odds ratio [OR] = 3.8; 95% confidence interval [CI], 1.1 to 13), a severely limited activity level (OR = 9.7; 95% CI, 2.5 to 37), and a creatinine clearance of less than 0.83 mL/s (OR = 6.8; 95% CI, 2.8 to 16) were all independently associated with an increased risk of postoperative mortality. The mortality rate in patients with two or more of these risk factors was 20%, nearly eight times higher (95% CI, 3.6 to 16) than those with one or no risk factors. An additional 82 patients died within the next 2 years; cancer, renal dysfunction, congestive heart failure, and obstructive pulmonary disease were independently associated with long-term mortality. CONCLUSIONS--Even in patients at high risk of cardiac complications following surgery, noncardiac causes of death are more common. Patients with a history of hypertension, severely limited activity, and reduced renal function appear to be at especially high risk of in-hospital mortality after noncardiac surgery.     

Management of stable angina

Ischaemic heart disease may present as a wide variety of clinical entities including unstable or stable angina pectoris, acute myocardial infarction, and occasionally heart failure. Chronic stable angina is a common condition and results in a considerable burden for both the individual and society. The goals in management are (i) treatment of other conditions that may worsen angina; (ii) modification of risk factors and treatment with medications for coronary artery disease to improve outcome; and (iii) effective relief of anginal symptoms. There are limitations to the methods available to risk-stratify patients, and the optimal treatment strategy remains unclear. The benefits of lifestyle modification cannot be over-emphasised, and appropriate attention to modifiable risk factors is paramount. The mortality benefit of lipid lowering treatment and antiplatelet therapy is well proved. However the evidence base for anti-ischaemic therapy is less rigorous, being based mainly on extrapolations from studies of acute coronary syndromes. Angioplasty has been shown to be more effective in relief of symptoms than medical therapy alone, but provides no mortality benefit. Coronary artery bypass surgery, however, has been shown to reduce mortality in patients with severe proximal coronary disease when compared with medical management alone.     

Coronary artery surgery.

Coronary artery disease has been described as the largest public health problem in Western society. In spite of the many advances in recent years in its medical management, many patients remain disabled even after optimal medical therapy. The aortocoronary bypass operation, introduced in the mid-1960s, has been shown to have consistent subjective and objective effects on the course of the disease in a large proportion of patients. The procedure consists of inserting a portion of the saphenous vein into both the aorta and a coronary artery to bypass the obstruction. It is usual now to bypass obstructions in several coronary arteries at the same operation if necessary. The prognosis for patients with ischemic heart disease with medical management depends on the extent of the disease. Patients with obstruction of only one coronary artery have a prognosis very little different from normal. On the other hand, obstruction of several arteries is consistently associated with a mortality approaching or exceeding 10% per year.     

桥血管狭窄患者介入治疗影响预后的因素分析

目的：分析冠脉搭桥术后桥血管狭窄成功行介入治疗患者的基线资料特点,探讨原位血管及桥血管介入治疗、支架种类与桥血管狭窄行介入治疗患者预后的关系.方法：对入选的281例桥血管病变患者进行随访,统计基线资料,观察主要不良心血管事件（MACE）的情况,分为MACE组及无MACE组.对可疑影响MACE发生的危险因素行Logistic回归分析,得出影响该类人群预后的独立危险因素,采用Kaplan-Meier生存曲线Log-rank检验原位血管与桥血管介入治疗策略、药物涂层支架与裸支架对生存率的影响及区别.结果：在基线资料方面：年龄、性别、肥胖、高血压病史、吸烟史、高脂血症病史、冠心病家族史、既往心肌梗死病史、心功能情况及冠心病类型方面两组均无统计学差异（P＞0.05）,在血糖、胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平中具有统计学差异（P值分别为0.003、0.02i、0.014及0.014）,糖尿病、HDL-C、支架直径及支架长度与桥血管介入治疗后发生MACE独立相关.原位血管组及桥血管组在发生MACE方面的差异具有统计学意义（P=0.008）,在原位血管及桥血管介入治疗后随访的MACE中,药物洗脱支架（DES）与金属裸支架（BMS）组在MACE发生率中具有统计学差异.结论：糖尿病与支架长度是影响桥血管狭窄介入治疗预后的危险因素;HDL-C及支架直径为预后的保护因素;原位血管与桥血管的介入治疗策略比较中,原位血管的预后优于桥血管.     

Risks of discontinuing anticoagulant therapy in a selected group of patients with atherosclerotic heart disease: a prospective study

In 134 patients with coronary artery disease, long-term oral anticoagulant therapy (mean duration, 56 months) for acute myocardial infarction (98 patients), acute coronary insufficiency (25 patients) or severe chronic angina (11 patients) was terminated abruptly in 50 patients (group 1) and gradually in 84 (group 2). The 134 patients represented a homogeneous population of patients with coronary artery disease since most patients older than 75 years and those with conditions known to increase the risks of thromboembolic complications were excluded. The two groups were comparable in terms of sex, age, presence of risk factors, duration of anticoagulant therapy, and presence of angina and abnormal resting electrocardiograms during therapy. Patients were evaluated 6 months after cessation of anticoagulant therapy and, since abrupt withdrawal of therapy did not carry a higher risk than gradual discontinuation, data for groups 1 and 2 were tabulated together.

Of the 84 patients with angina at the end of therapy 15 experienced an increase in its severity and this symptom appeared in another patient (relapse rate, 18%). Angina progressed to fatal acute myocardial infarction in four (mortality, 3%) and nonfatal infarction in two; however, all six had extensive coronary artery disease and poor left ventricular function. The results of this study suggest that neither abrupt nor gradual cessation of anticoagulant therapy is associated with an inordinate exacerbation of heart disease.

     

Predictive value of the ear-crease sign in coronary artery disease.

The value of the ear-crease sign in predicting the presence of coronary artery disease was studied in 340 consecutive patients who underwent coronary arteriography. In this selected population, 75.6% of whom had coronary artery disease, the sensitivity of the sign was 59.5%, the specificity 81.9% and the positive predictive value 91.1%. The sign was associated with increasing age but was also independently associated with obstructive coronary artery disease. No significant correlation was found between the sign and the presence of risk factors or other signs of such disease, except for corneal arcus. In symptomatic patients the sign suggested the presence of more extensive coronary artery disease. In an asymptomatic population with a low prevalence of coronary artery disease it appears to be of limited value in predicting obstructive coronary artery disease. However, it may identify a subset of patients prone to early ageing and to the early development of coronary artery disease, whose prognosis might be improved by early preventive measures.     

心血管危险因素对严重急性呼吸综合征分型及预后的影响

为分析研究常见心血管危险因素对严重急性呼吸综合征(SARS)病人分型及预后的影响,对219例严重急性呼吸综合征病人进行分析,研究各年龄组及性别与SARS分型的关系,观察高血压、冠心病、糖尿病等基础疾病对此种疾病分型的影响,观察轻型、重型、极重型SARS病人的血糖、血脂、血压、血尿酸等指标的变化及其与SARS分型的关系。结果60岁以上老年人中重型及极重型病人的比例高于轻型组,且高于其他年龄组,而既往有高血压、糖尿病、冠心病等基础病者中重型及极重型病人明显多于无基础病变者。重型及极重型病人的血糖及收缩压水平明显高于轻型患者,极重型病人血尿酸水平低于轻型患者,而性别、血胆固醇、三酰甘油等指标与SARS分型无明显关系。提示年龄、高血压、高血糖等心血管危险因素对于SARS的分型及预后具有一定的影响,而性别、血胆固醇、三酰甘油水平对其分型无明显影响。     

直肠癌术后患者生存状况的相关因素研究

目的:探讨对直肠癌患者术后生存状况产生影响的相关因素,为评估疾病的预后提供可靠依据。方法:采用回顾性调查统计的方式,选取于2007年2月至2010年5月到我院普外科就诊的直肠癌患者93例,对患者或家属进行问卷调查的形式采集病史,并结合患者住院期间相关检查,统计分析患者生存时间及生存质量评分,采用Log-rank单因素分析及Cox比例风险回归分析,从而确定影响直肠癌患者术后生存状况的相关因素。结果:93例直肠癌患者中,手术后生存时间最长为7年,最短为6个月,中位时间为(1.51±0.24)年,两年生存36例,两年生存率38.71%。患者生存状况与性别、受教育程度、高血压、糖尿病、术前癌胚抗原(carcinoembryonic antigen,CEA)水平没有显著相关性(P>0.05),而与年龄、收入情况、负性情绪事件、肿瘤大小、淋巴结转移、浸润深度、手术方式、化疗与否相关(P<0.05)。结论:直肠癌患者术后生存状况与多方面因素相关,在患者诊断及治疗过程中要综合考虑各因素在疾病进展及预后中起到的作用。     

Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease.

OBJECTIVE--To evaluate the hypothesis that diminished social and economic resources impact adversely on cardiovascular mortality in patients with coronary artery disease. DESIGN--Inception cohort study of patients undergoing cardiac catheterization from 1974 through 1980 and followed up through 1989. SETTING--Tertiary care university medical center. PATIENTS--Consecutive sample of 1965 medically treated patients with stenosis 75% or greater of at least one major coronary artery. Five hundred patients were not enrolled due to logistic problems; 33 refused; 64 had missing data on key medical variables. The final study population included 1368 patients, 82% male, with a median age of 52 years. MAIN OUTCOME MEASURE--Survival time until cardiovascular death. RESULTS--Independent of all known baseline invasive and noninvasive medical prognostic factors, patients with annual household incomes of $40,000 or more had an unadjusted 5-year survival of 0.91, compared with 0.76 in patients with incomes of $10,000 or less (Cox model adjusted hazard ratio, 1.9; 95% confidence interval, 1.57 to 2.32; P = .002). Similarly, unmarried patients without a confidant had an unadjusted 5-year survival rate of 0.50, compared with 0.82 in patients who were married, had a confidant, or both (adjusted hazard ratio, 3.34; 95% confidence interval, 1.84 to 6.20; P less than .0001). CONCLUSIONS--Low levels of social and economic resources identify an important high-risk group among medically treated patients with coronary artery disease, independent of important medical prognostic factors. Additional study will be required to see if interventions to increase these resources improve prognosis.     

Assessing the Economic Attractiveness of Coronary Artery Revascularization in Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is associated with increased morbidity and mortality in coronary artery disease (CAD) patients. We compared the economic attractiveness of CAD revascularization procedures in patients with and without CKD. Our population included 6218 patients with significant CAD undergoing cardiac catheterization at Duke University between 1996 and 2001, with follow-up through 2002. We investigated the influence of CKD (creatinine clearance < 60 mL/min) upon 3-year survival and medical costs in our CAD population. Coronary artery bypass graft (CABG) surgery was an economically attractive alternative vs. percutaneous coronary intervention (PCI) or medical therapy for all patients with left main disease, three-vessel CAD patients without CKD, and two-vessel CAD patients with CKD. Medical therapy was an economically attractive strategy vs. CABG surgery or PCI for three-vessel CAD patients with CKD, two-vessel CAD patients without CKD, and all single-vessel CAD patients.     

Management of chronic stable angina pectoris from a sceptic's view point

Ischaemic heart disease is a leading cause of death in the world. It has clinically defined phases as: Asymptomatic, stable angina, progressive angina and unstable angina. It is important to differentiate patients of angina into those with stable and unstable angina--risk stratification and management differ in the two groups. Risk stratification of patients with stable angina using clinical parameters helps in development of clearer indication of referral for exercise testing and cardiac catheterisation. Chronic stable angina patients with history of documented myocardial infarction of Q waves on ECG should have measurement of left ventricular systolic function (ie, ejection fraction) as it is important for choosing the appropriate medical or surgical therapy. Symptomatic patients with suspected or known coronary artery disease should usually undergo exercise testing to assess the risk of future cardiac events. The treatment of stable angina has two purposes: To prevent myocardial infarction and death and therapy directed towards preventing death. Pharmacotherapy consists of: Aspirin, lipid lowering agents, beta-blockers, nitrates, short acting dihydropyridine calcium antagonists, etc. For surgery, there are two well established approaches of revascularisation. One is coronary artery by-pass grafting and the other is percutaneous transluminal coronary angioplasty. Studies comparing different treatment modalities are elaborated in this article. In conclusion, it can be said that patients having severe symptoms affecting quality of life despite optimal medical therapy should be referred for revascularisation surgery.     

66例颊粘膜癌的治疗与预后分析

目的 分析影响颊粘膜癌预后的因素,探讨合适的治疗方式。方法 选择中山大学肿瘤防治中心1992年至2003年住院治疗的初诊口颊癌患者66例进行回顾性研究。所有患者均接受了治疗,包括手术、放疗、化疗或以手术为主的综合治疗,随访3年以上。结果 5例患者行姑息性化疗,不作远期生存分析。行根治性治疗的61例患者总的3年、5年生存率分别为62.9%、52.9%。Ⅰ期、Ⅱ期病例较Ⅲ期、Ⅳ期病例预后好。单纯手术治疗早期患者预后好,5年生存率为85.1%。中晚期患者单纯手术治疗预后差,结合放疗、化疗综合治疗可提高远期生存率。颊肌侵犯、分期是影响预后的独立因素。结论 口颊癌侵袭性强,预后尚不满意,对于Ⅰ期、Ⅱ期患者单纯手术治疗是合适的,也可选择放疗。但晚期患者,我们主张采取以手术为主,结合化疗、放疗综合治疗。     

老年人前交通动脉瘤并发脑内脑室内出血的危险因素及预后分析

目的：探讨老年人和中青年人前交通动脉（AComA）动脉瘤破裂后并发脑内血肿（ICH）和（或）脑室内血肿（IVH）的危险因素及预后。方法：回顾性纳入2007年12月至2016年1月温州医科大学附属第一医院神经外科收治的285例AComA动脉瘤破裂后并发ICH和（或）IVH的患者,其中95例行夹闭术,140例行栓塞治疗,50例行保守治疗。根据年龄将285例患者分2组：≤60岁168例,＞60岁117例。术前对所有患者行CTA检查,并测量动脉瘤的形态学参数。采用单因素和多因素logistic回归方法分析老年人和中青年人AComA动脉瘤破裂后合并ICH和（或）IVH的危险因素及预后。结果：单因素分析显示,2组患者性别、高血压 史、吸烟史、血管角度、入射角度、治疗方式及GOS评分差异有统计学意义（P＜0.05）。多因素logistic回归分析显示,高血压史（OR=1.858,95%CI=1.083～3.188,P=0.025）,入射角度（OR=1.016,95%CI=1.004～1.028,P=0.010）和治疗方式（栓塞 vs. 保守治疗,OR=0.209,95%CI=0.088～0.497,P＜0.001;夹闭 vs. 保守治疗,OR=0.233,95%CI=0.101～0.541,P=0.001）与老年人AComA动脉瘤破裂后并发ICH和（或）IVH密切相关。老年组不同治疗方式的预后分析显示,接受外科治疗的患者预后相对较好[栓塞 vs. 保守治疗（OR=0.134,95%CI=0.049～0.362,P＜0.001）;夹闭 vs. 保守治疗（OR=0.308,95%CI=0.116～0.820,P=0.018）]。结论：高血压和较大动脉瘤入射角是AComA动脉瘤破裂后并发ICH和（或）IVH的危险因素,而老年人更加明显。老年组手术比率明显低于中青年组,但接受手术治疗后的老年组患者仍有较好的预后。     

川崎病静脉内注射丙种球蛋白治疗耐药的危险因素积分的临床意义

目的：探讨川崎病患儿大剂量静脉内注射丙种球蛋白（IVIG）耐药的危险因素积分的临床意义。方法回顾性分析2009年至2014年收治的256例川崎病患儿的临床资料,通过 IVIG 耐药的危险因素加权积分,统计分析危险因素加权积分对 IVIG疗效及冠状动脉损伤的影响。结果与 IVIG 治疗有效的患儿相比,IVIG 治疗无效的患儿具有更高的谷草转氨酶（AST）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）、总胆红素和 C 反应蛋白（P 均<0.05）;相反,IVIG 治疗无效的患儿血小板和血钠均降低（ P 均<0.05）;危险因素积分≥3更容易发生 IVIG 治疗无反应（OR =10.470,P <0.05）;并且 IVIG 耐药的危险因素积分≥3的患儿更容易并发冠状动脉损伤（OR =7.941,P =0.003）。结论 IVIG 耐药的危险因素加权积分可更好地预测川崎病患儿的 IVIG 无反应性和并发冠状动脉损伤情况。     

合并颈动脉狭窄的冠状动脉搭桥发生围手术期缺血性 脑卒中的常见因素分析

目的：分析同时合并有颈动脉疾病的冠心病患者围手术期发生缺血性脑卒中的常见因素,以提高对该类 疾病的治疗效果。方法：收集2008年至2014年厦门大学附属第一医院收治的44例多支冠状动脉病变合并颈动脉狭窄 的患者,其中男性32例,女性12例。所有患者在处理颈部病变后再接受冠状动脉旁路移植术。对其手术效果及随访 结果进行回顾性分析。结果：1例接受颈动脉内膜剥脱术的患者术后出现偏瘫,经治疗后临床症状改善。短暂性脑缺 血发作1例,5例患者在术后1周再发脑血管后循环梗死。12例患者术后48 h内出现神经损伤表现。早期使用主动脉内 球囊反搏9例,二次开胸止血1例,胸骨哆开3例;术后早期出现心房颤动27例。总计死亡2例。随访1~7年,随访率为 90%,44例患者脑缺血症状获得不同程度的改善。6例患者诉心绞痛症状再发,但复查冠状动脉造影或冠状动脉CT血 管造影无异常发现,随访期间1例患者因恶性肿瘤死亡。结论：接受冠状动脉搭桥手术的患者一旦合并颈动脉疾病, 其缺血性脑卒中发生的概率更高,但颈动脉狭窄并不是该类患者发生围手术期卒中的唯一原因,其他危险因素同样 不容忽视。     

Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group.

OBJECTIVE--To determine the long-term (2-year) cardiac prognosis of high-risk patients undergoing noncardiac surgery and to determine the predictors of long-term adverse cardiac outcome. DESIGN--Prospective cohort study. Historical, clinical, and laboratory data were collected during the in-hospital period, and at 6 months, 1 year, and 2 years following surgery. Data were analyzed using proportional hazards models. SETTING--University-affiliated Veterans Affairs medical center. POPULATION--A consecutive sample of 444 patients with or at high risk for coronary artery disease who had undergone elective noncardiac surgery and were discharged from the hospital in stable condition. MAIN OUTCOME MEASURES--Cardiac death, myocardial infarction, unstable angina, progressive angina requiring coronary artery bypass graft surgery or coronary angioplasty, and new unstable angina requiring hospitalization. RESULTS--Forty-seven patients (11%) had major cardiovascular complications during a 728-day (median) follow-up period: 24 had cardiac death; 11, nonfatal myocardial infarction; six, progressive angina requiring coronary artery bypass graft surgery or coronary angioplasty; and six, new unstable angina requiring hospitalization. Thirty percent of outcomes occurred within 6 months of surgery and 64% within 1 year. Five independent predictors of long-term outcome were identified. Three predictors reflected the preexisting chronic disease state: (1) the presence of known vascular disease (hazard ratio, 6.1; 95% confidence interval [CI], 2.5 to 15.0; P less than .0001); (2) a history of congestive heart failure (hazard ratio, 5.0; 95% CI, 2.0 to 12.0; P less than .0005); and (3) known coronary artery disease (hazard ratio, 3.7; 95% CI, 1.7 to 8.0; P less than .0007). Two predictors reflected acute postoperative ischemic events: (1) myocardial infarction/unstable angina (hazard ratio, 20; 95% CI, 7.5 to 53.0; P less than .0001) and (2) myocardial ischemia (hazard ratio, 2.2; 95% CI, 1.1 to 4.3; P less than .03). Patients surviving a postoperative in-hospital myocardial infarction had a 28-fold increase in the rate of subsequent cardiac complications within 6 months following surgery, a 15-fold increase within 1 year, and a 14-fold increase within 2 years (95% CI, 5.8 to 32; P less than .00001). Seventy percent of all long-term adverse outcomes were preceded by in-hospital postoperative ischemia that occurred at least 30 days (median, 282 days) before the long-term event. The development of congestive heart failure or ventricular tachycardia (without ischemia) during hospitalization was not associated with adverse long-term outcome. CONCLUSIONS--The incidence of long-term adverse cardiac outcomes following noncardiac surgery is substantial. At increased risk are patients with chronic cardiovascular disease; at highest risk are patients with acute perioperative ischemic events. We conclude that survivors of in-hospital perioperative ischemic events, specifically myocardial infarction, unstable angina, and postoperative ischemia, warrant more aggressive long-term follow-up and treatment than is currently practiced.     

严重左主干病变急救处理及急诊搭桥术对病人预后的影响

目的 :探讨严重左主干病变病人不同处理方案以及外科搭桥队伍对临床预后的影响。方法 :回顾性分析了左主干冠状动脉狭窄 >70 %病人的临床预后。结果 :发现严重左主干病变 2 4例 ,冠状动脉造影后无明显症状者 17例 ( 71%) ,5例在 2 4h内 ,12例在 72h内接受了冠状动脉搭桥术 (coronaryarterybypassgrafting ,CABG) ,手术成功 10 0 %,住院期间无死亡 ;7例病人在冠状动脉造影后出现心肌缺血症状 ,其中 6例在出现症状后立即出现室性心动过速 ,4例在导管室内复苏成功的病人 ,立即成功植入主动脉球囊反搏 (IABP)并行急诊CABG术 ,手术成功率10 0 %,住院期间无死亡 ;1例在复苏的同时和延迟的IABP支持下 ,成功植入左主干支架 ,1例在复苏的同时未能成功植入IABP ,行抢救性CABG ,但 2例病人均于术后 12h死于心源性休克 ;第 7例病人在冠造后 12h ,出现严重心绞痛及反复室性心动过速死亡。结论 :严重左主干病变病人预后凶险 ,特别是冠造后有明显缺血症状的病人 ;及时置入IABP和急诊搭桥术多能改善病人预后 ,否则病人 2 4h内预后极差