Parisi A F, Folland E D, Hartigan P
Research Service, Veterans Affairs Medical Center, West Roxbury, Mass.
N Engl J Med. 1992 Jan 2;326(1):10-6. doi: 10.1056/NEJM199201023260102.
Despite the widespread use of percutaneous transluminal coronary angioplasty (PTCA), only a few prospective trials have assessed its efficacy. We compared the effects of PTCA with those of medical therapy on angina and exercise tolerance in patients with stable single-vessel coronary artery disease.
Patients with 70 to 99 percent stenosis of one epicardial coronary artery and with exercise-induced myocardial ischemia were randomly assigned either to undergo PTCA or to receive medical therapy and were evaluated monthly. The patients assigned to PTCA were urged to have repeat angioplasty if their symptoms suggested restenosis. After six months, all the patients had repeat exercise testing and coronary angiography.
A total of 107 patients were randomly assigned to medical therapy and 105 to PTCA. PTCA was clinically successful in 80 of the 100 patients who actually had the procedure, with an initial reduction in mean percent stenosis from 76 to 36 percent. Two patients in the PTCA group required emergency coronary-artery bypass surgery. By six months after the procedure, 16 patients had had repeat PTCA. Myocardial infarction occurred in five patients assigned to PTCA and in three patients assigned to medical therapy. At six months 64 percent of the patients in the PTCA group (61 of 96) were free of angina, as compared with 46 percent of the medically treated patients (47 of 102; P less than 0.01). The patients in the PTCA group were able to increase their total duration of exercise more than the medical patients (2.1 vs. 0.5 minutes, P less than 0.0001) and were able to exercise longer without angina on treadmill testing (P less than 0.01).
For patients with single-vessel coronary artery disease, PTCA offers earlier and more complete relief of angina than medical therapy and is associated with better performance on the exercise test. However, PTCA initially costs more than medical treatment and is associated with a higher frequency of complications.
尽管经皮腔内冠状动脉成形术（PTCA）已广泛应用，但仅有少数前瞻性试验评估过其疗效。我们比较了PTCA与药物治疗对稳定型单支冠状动脉疾病患者心绞痛及运动耐量的影响。
对一支心外膜冠状动脉狭窄70%至99%且有运动诱发心肌缺血的患者，随机分配接受PTCA或药物治疗，并每月进行评估。分配接受PTCA的患者若症状提示再狭窄，会被敦促再次进行血管成形术。六个月后，所有患者再次进行运动试验和冠状动脉造影。
共107例患者被随机分配接受药物治疗，105例接受PTCA。在实际接受该手术的100例患者中，80例PTCA手术临床成功，平均狭窄百分比最初从76%降至36%。PTCA组有2例患者需要急诊冠状动脉搭桥手术。术后六个月，16例患者再次接受PTCA。PTCA组有5例患者发生心肌梗死，药物治疗组有3例。六个月时，PTCA组64%的患者（96例中的61例）无心绞痛，而药物治疗组为46%（102例中的47例；P<0.01）。PTCA组患者运动总时长增加幅度大于药物治疗组患者（2.1分钟对0.5分钟，P<0.0001），且在跑步机测试中无胸痛情况下能运动更长时间（P<0.01）。
对于单支冠状动脉疾病患者，PTCA比药物治疗能更早、更完全地缓解心绞痛，且运动试验表现更佳。然而，PTCA初始费用高于药物治疗，且并发症发生率更高。
