Schunkert H, Harrell L, Palacios I F
Department of Medicine, Massachusetts General Hospital, Boston, USA.
J Am Coll Cardiol. 1999 Jul;34(1):40-8. doi: 10.1016/s0735-1097(99)00181-3.
The purpose of this study was to determine whether small reference diameter of the culprit coronary artery influences the outcome of an attempted percutaneous revascularization procedure in the current era of interventional cardiology.
Although the interventional strategy is largely determined by the size of the culprit coronary artery, earlier quantitative studies have not shown a worse acute outcome for small reference vessel diameter (< or =2.5 mm).
A total of 2,306 patients undergoing percutaneous coronary revascularization was divided in groups with reference diameters < or =2.5 mm (n = 813) or >2.5 mm (n = 1,493). Success and in-hospital major adverse cardiac event (death, Q-wave myocardial infarction and emergency coronary artery bypass graft) rates between both groups were compared.
Patients with lesions in small vessels were older and presented more frequently with female gender, diabetes mellitus, heart failure, peripheral vascular, multivessel coronary disease and American Heart Association/American College of Cardiology (AHA/ACC) lesion type C (p < or = 0.01, each). Further, utilization of interventional devices differed markedly. In contrast to stents (18.5% vs. 41.9%) and directional atherectomy (3.7% vs. 13.5%), conventional balloon angioplasty (73% vs. 50%) and rotational atherectomy (16.1% vs. 8.3%) were used more often in smaller vessels (p < or = 0.0001, each). Success rate was lower in the small vessel group (92% vs. 95%; p = 0.006). Major adverse cardiac events occurred more frequently in small than large vessels (univariate 3.4% vs. 2.0%, p = 0.03; multivariate odds ratio 2.1, p = 0.02), particularly when proximal coronary segments were compared.
Lesions in vessels with small reference diameter represent a distinct group with respect to clinical and morphologic characteristics as well as device utilization. These lesions have lower chances of successful percutaneous intervention and carry relatively higher risks, specifically when located in proximal coronary segments.
本研究旨在确定在当代介入心脏病学时代，罪犯冠状动脉的参考直径较小是否会影响经皮血管重建术的治疗结果。
尽管介入策略在很大程度上由罪犯冠状动脉的大小决定，但早期的定量研究并未显示参考血管直径较小（≤2.5毫米）会导致更差的急性治疗结果。
总共2306例行经皮冠状动脉血管重建术的患者被分为参考直径≤2.5毫米组（n = 813）和＞2.5毫米组（n = 1493）。比较两组之间的成功率和院内主要不良心脏事件（死亡、Q波心肌梗死和急诊冠状动脉旁路移植术）发生率。
小血管病变患者年龄更大，女性、糖尿病、心力衰竭、外周血管疾病、多支冠状动脉疾病以及美国心脏协会/美国心脏病学会（AHA/ACC）C型病变的发生率更高（各p≤0.01）。此外，介入器械的使用有显著差异。与支架（18.5%对41.9%）和定向旋切术（3.7%对13.5%）相比，传统球囊血管成形术（73%对50%）和旋磨术（16.1%对8.3%）在较小血管中的使用更为频繁（各p≤0.0001）。小血管组的成功率较低（92%对95%；p = 0.006）。小血管中主要不良心脏事件的发生率高于大血管（单因素分析3.4%对2.0%，p = 0.03；多因素优势比2.1，p = 0.02），尤其是比较冠状动脉近端节段时。
参考直径较小的血管病变在临床和形态学特征以及器械使用方面代表了一个独特的群体。这些病变成功进行经皮介入治疗的机会较低，且风险相对较高，特别是位于冠状动脉近端节段时。
