Marzocchi A, Ortolani P, Piovaccari G, Marrozzini C, Palmerini T, Marinucci L, Saia F, Bacchi-Reggiani M L, Branzi A, Magnani B
Istituto di Malattie Cardiovascolari, Università degli Studi, Bologna.
Cardiologia. 1999 Mar;44(3):261-8.
Stent-like plain old balloon angioplasty (POBA, < or = 30% residual diameter stenosis) in patients with stable angina resulted in a clinical and angiographic long-term outcome equivalent to stenting. In unstable angina POBA showed lower acute and long-term efficacy than in the stable setting. Data comparing stent-like POBA and coronary stenting in unstable angina are lacking in the literature. The aim of this retrospective single-center study was to compare the long-term effectiveness of stent-like POBA and coronary stenting in unstable angina. From January 1996 to December 1996 we retrospectively examined 187 consecutive patients with unstable angina who underwent coronary angioplasty on a native vessel: 135 had coronary stenting in addition to POBA and 50 achieved a stent-like result with POBA. Two patients, with major contraindication to coronary stenting, who did not reach a stent-like angiographic result, were also treated with only POBA but were excluded from the study. Stent implantation indications were: elective (54 stents, 30%), suboptimal angiographic result (104 stents, 58%), and bail-out situation (21 stents, 12%). Stent implantation showed high angiographic (98.5%) and clinical (95.5%) success. Stent thrombosis occurred only in 2 patients (1.5%). At quantitative coronary angiography the stent group showed a higher post-procedure minimal lumen diameter (2.74 +/- 1.25 vs 2.27 +/- 0.58 mm, p = 0.025), acute gain (1.95 +/- 1.28 vs 1.43 +/- 0.57 mm, p = 0.007) and lower residual stenosis diameter (13.89 +/- 7.43 vs 20.4 +/- 7.28%, p = 0.001) than the stent-like POBA group. At 1-year follow-up the stent group showed a higher event-free survival rate (77.9 vs 64.6%, p = 0.009) mainly due to lower recurrence of angina and repetition of percutaneous procedures. Stent-like POBA procedure and baseline lesion length > or = 10 mm proved to be the only independent predictors of long-term ischemic event occurrence. In conclusion, in unstable angina, stent implantation appears more effective than stent-like POBA to avoid long-term ischemic complications.
在稳定型心绞痛患者中，采用类似支架的普通球囊血管成形术（POBA，残余直径狭窄≤30%）所获得的临床和血管造影长期结果与支架植入术相当。在不稳定型心绞痛患者中，POBA的急性和长期疗效低于稳定型心绞痛患者。文献中缺乏比较不稳定型心绞痛患者中类似支架的POBA和冠状动脉支架植入术的相关数据。这项回顾性单中心研究的目的是比较不稳定型心绞痛患者中类似支架的POBA和冠状动脉支架植入术的长期有效性。1996年1月至1996年12月，我们回顾性研究了187例连续接受天然血管冠状动脉成形术的不稳定型心绞痛患者：135例除POBA外还接受了冠状动脉支架植入术，50例通过POBA获得了类似支架的效果。2例有冠状动脉支架植入术主要禁忌证且未达到类似支架血管造影结果的患者仅接受了POBA治疗，但被排除在研究之外。支架植入的适应证为：择期（54个支架，30%）、血管造影结果欠佳（104个支架，58%）和补救情况（21个支架，12%）。支架植入显示出较高的血管造影成功率（98.5%）和临床成功率（95.5%）。仅2例患者（1.5%）发生支架血栓形成。在定量冠状动脉造影中，支架组术后最小管腔直径更高（2.74±1.25 vs 2.27±0.58 mm，p = 0.025）、急性增加量更大（1.95±1.28 vs 1.43±0.57 mm，p = 0.007）且残余狭窄直径更低（13.89±7.43 vs 20.4±7.28%，p = 0.001），高于类似支架的POBA组。在1年随访时，支架组显示出更高的无事件生存率（77.9% vs 64.6%，p = 0.009），主要是由于心绞痛复发率和经皮操作重复率较低。类似支架的POBA操作和基线病变长度≥10 mm被证明是长期缺血事件发生的唯一独立预测因素。总之，在不稳定型心绞痛中，支架植入术在避免长期缺血并发症方面似乎比类似支架的POBA更有效。
