Loubeyre C, Morice M C, Berzin B, Virot P, Commeau P, Drobinski G, Ethevenot G, Moquet B, Marco J, Labrunie P, Cattan S, Coste P, Aubry P, Ferrier A
Institut Cardiovasculaire Paris Sud, Quincy, France.
Catheter Cardiovasc Interv. 1999 Aug;47(4):441-8. doi: 10.1002/(SICI)1522-726X(199908)47:4<441::AID-CCD12>3.0.CO;2-S.
This study investigates the influence of coronary stenting on the risk of emergency bypass surgery performed within 24 hr of percutaneous transluminal coronary angioplasty (PTCA) with particular concern for incidence and indication. Since 1995, coronary stenting has been increasingly performed in France during angioplasty procedures, altering significantly the role of emergency bypass surgery. The outcome of elective stenting and widespread use of coronary stenting and its influence on emergency surgery have not been evaluated so far. Through a retrospective (1995) and prospective (1996) registry, we analyzed the incidence, indication and results of emergency bypass surgery performed within 24 hr of PTCA in 68 and 57 centers, respectively, accounting for nearly half of all angioplasty procedures in France. Data were collected through questionnaires consisting of separate forms for every case report that were sent to every center. Over the two years, 26,885 and 27,497 procedures were investigated with a stenting rate of 46% and 64%, respectively. The observed need for emergency surgery was constantly low throughout this period (0.38% and 0.32%, respectively). Indications for surgery included complications directly due to stent in 37% of cases in the 2-year period. Outcome remained poor, with in-hospital mortality in 10% and 17% and myocardial infarction in 27% and 25% of cases, respectively. A comparison of the results in centers with and without surgical facilities showed no differences in outcome, despite a longer time to surgery (359 min +/- 406 min vs. 170 min +/- 205 min, P = 0.0001) and a lower incidence of emergency surgery (0.25% vs. 0.44%, P = 0.0001) in centers without on-site surgery backup. The French multicenter registry reveals an increase in the use of stents together with a dramatic decrease in the incidence of emergency bypass surgery (below 0.5%) following PTCA. There has been a significant evolution in the indication, and stent implantation now accounts for a third of the indications for emergency bypass surgery.
本研究调查冠状动脉支架置入术对经皮腔内冠状动脉成形术（PTCA）后24小时内进行急诊搭桥手术风险的影响，尤其关注其发生率和适应证。自1995年以来，法国在血管成形术过程中越来越多地进行冠状动脉支架置入术，这显著改变了急诊搭桥手术的作用。目前尚未评估择期支架置入术的结果、冠状动脉支架置入术的广泛应用及其对急诊手术的影响。通过回顾性（1995年）和前瞻性（1996年）登记，我们分别分析了在68个和57个中心PTCA后24小时内进行的急诊搭桥手术的发生率、适应证和结果，这些中心占法国所有血管成形术的近一半。数据通过问卷收集，问卷由针对每个病例报告的单独表格组成，并发送到每个中心。在这两年中，分别对26,885例和27,497例手术进行了调查，支架置入率分别为46%和64%。在此期间，观察到的急诊手术需求一直较低（分别为0.38%和0.32%）。手术适应证包括在两年期间37%的病例中直接由支架引起的并发症。结果仍然很差，住院死亡率分别为10%和17%，心肌梗死发生率分别为27%和25%。对有和没有手术设施的中心的结果进行比较，结果显示尽管没有现场手术支持的中心手术时间更长（359分钟±406分钟对170分钟±205分钟，P = 0.0001）且急诊手术发生率更低（0.25%对0.44%，P = 0.0001），但结果并无差异。法国多中心登记显示，PTCA后支架使用增加，同时急诊搭桥手术的发生率显著下降（低于0.5%）。适应证有了显著变化，现在支架植入占急诊搭桥手术适应证的三分之一。
