Iliadis E A, Zaacks S M, Calvin J E, Allen J, Parrillo J E, Klein L W
Rush Presbyterian-St. Luke's Medical Center and Rush Heart Institute, Chicago, Illinois, USA.
Angiology. 2000 Jan;51(1):39-52. doi: 10.1177/000331970005100108.
As coronary interventional technology improves, the influence of lesion length (LL) on procedural success and device selection may vary. Thus, the authors prospectively analyzed 957 consecutive coronary interventions (CI) in 1,404 stenoses to ascertain the influence of lesion length on CI outcome. Stenosis morphology was prospectively classified by the AHA/ACC criteria. LL was analyzed both as dichotomous (S: < 10 mm, L: > 10 mm) variables and by the three-tiered AHA/ACC criteria (I: < 10 mm, II: 10-20 mm, III: > 20 mm). There was a significant univariate relationship between CI success and S stenosis (S: 95.8% vs L: 91.8%, p = 0.002 and I: 96.0%, II: 91.7%, III: 89.3%). Numerous interrelationships involving the morphologic characteristics were noted: lesion morphologies associated with S lesions were concentric (p = 0.0001) and had smooth contour (p = 0.0001), ostial location (p = 0.05) and little calcification (p = 0.0007), while irregular contour (p=0.0001), calcification (p=0.0076), eccentric (p=0.0001), thrombus (p = 0.0001), recent (p = 0.0001) or chronic (p = 0.001) total occlusion were associated with L lesions. When these relationships were taken into account by multiple logistic regression analysis, lesion length was not predictive of procedural outcome (p = 0.099). One morphologic type was associated with increased CI success: irregular contour (p = 0.022); recent (p < 0.0001) or chronic (< 0.0001) occlusions were associated with decreased CI success. Another factor considered was device selection: S lesions were associated with greater balloon angioplasty usage (p = 0.002), whereas more coronary stents (p = 0.024) and rotoblator (p = 0.018) devices were used in L lesions. More balloon angioplasty was performed in concentric (p < 0.0001) lesions; interventional devices were employed more often in eccentric (p < 0.0001) and irregular lesions (p < 0.0001). More complications were noted in lesions with thrombus (p = 0.0002), but lesion length was not predictive (p = NS). Lesion length is not a significant predictor of procedural success when adjusted for other lesion morphologies in the modern interventional era. The availability of new devices has improved the results in longer lesions since the AHA/ACC criteria were originally proposed.
随着冠状动脉介入技术的提高，病变长度（LL）对手术成功率和器械选择的影响可能会有所不同。因此，作者前瞻性分析了1404处狭窄病变的957例连续冠状动脉介入治疗（CI），以确定病变长度对CI结果的影响。狭窄形态根据美国心脏协会（AHA）/美国心脏病学会（ACC）标准进行前瞻性分类。LL被分析为二分变量（S：<10mm，L：>10mm）以及采用AHA/ACC的三级标准（I：<10mm，II：10 - 20mm，III：>20mm）。CI成功率与S狭窄之间存在显著的单变量关系（S：95.8% 对L：91.8%，p = 0.002；I：96.0%，II：91.7%，III：89.3%）。注意到许多涉及形态学特征的相互关系：与S病变相关的病变形态为同心性（p = 0.0001）、轮廓光滑（p = 0.0001）、开口处位置（p = 0.05）且钙化较少（p = 0.0007），而不规则轮廓（p = 0.0001）、钙化（p = 0.0076）、偏心性（p = 0.0001）、血栓（p = 0.0001）、近期（p = 0.0001）或慢性（p = 0.001）完全闭塞与L病变相关。当通过多因素逻辑回归分析考虑这些关系时，病变长度并不能预测手术结果（p = 0.099）。一种形态学类型与CI成功率增加相关：不规则轮廓（p = 0.022）；近期（p < 0.0001）或慢性（< 0.0001）闭塞与CI成功率降低相关。另一个考虑因素是器械选择：S病变与更多使用球囊血管成形术相关（p = 0.002），而L病变中使用更多的冠状动脉支架（p = 0.024）和旋磨术器械（p = 0.018）。同心性病变（p < 0.0001）中进行更多的球囊血管成形术；偏心性（p < 0.0001）和不规则病变（p < 0.0001）中更常使用介入器械。血栓病变（p = 0.0002）中注意到更多并发症，但病变长度无预测性（p = 无显著性差异）。在现代介入时代，当对其他病变形态进行校正后，病变长度并非手术成功的显著预测因素。自AHA/ACC标准最初提出以来，新器械的应用改善了较长病变的治疗结果。
