Kuntz R E, Hinohara T, Robertson G C, Safian R D, Simpson J B, Baim D S
Charles A. Dana Research Institute, Boston, Massachusetts.
Am J Cardiol. 1992 Nov 1;70(13):1101-8. doi: 10.1016/0002-9149(92)90037-y.
In comparing the restenosis rates among different interventions, 1 potential confounder might be the differences in the vessels treated, as dictated by the technical limitations of particular devices. The purpose of this study was to use current "acute gain-late loss" analysis to examine what influence vessel selection has on the restenosis rates seen after coronary stenting or directional atherectomy. The minimal luminal diameter of native coronary lesions was measured before and immediately after intervention in 102 single Palmaz-Schatz stents and 347 atherectomies, 367 (82%) of which had repeat angiographic measurement 6 months after intervention. Atherectomy-treated lesions had a higher proportion of left anterior descending to right coronary arteries (68 vs 24%) compared with stents (31 vs 54%), p < 0.001. Although subsequent restenosis rates were similar for stenting (25%) and atherectomy (30%, p = 0.42), left anterior descending versus right coronary lesions had a significantly higher restenosis rate for the overall group (35 vs 18%, p = 0.009), for stents (44 vs 13%, p = 0.008) and for atherectomy (35 vs 22%, p = 0.10), respectively. Multivariable analysis demonstrated that postprocedure luminal diameter (p = 0.03, p = 0.009) and coronary location (the proportion of left anterior descending vessels treated, p = 0.002, p < 0.001), but not device type (stent vs atherectomy), were strong independent determinants of restenosis according to both binary (> 50% diameter stenosis) and continuous (late percent stenosis) definitions.(ABSTRACT TRUNCATED AT 250 WORDS)
在比较不同干预措施的再狭窄率时，一个潜在的混杂因素可能是所治疗血管的差异，这取决于特定器械的技术限制。本研究的目的是运用当前的“急性增益-晚期丢失”分析，来检验血管选择对冠状动脉支架置入术或定向旋切术后再狭窄率有何影响。在102例单枚Palmaz-Schatz支架置入术和347例旋切术前后，测量了原位冠状动脉病变的最小管腔直径，其中367例（82%）在干预后6个月进行了重复血管造影测量。与支架组（左前降支与右冠状动脉的比例为31% vs 54%）相比，旋切术治疗的病变中左前降支与右冠状动脉的比例更高（68% vs 24%），p<0.001。尽管随后支架置入术（25%）和旋切术（30%，p=0.42）的再狭窄率相似，但左前降支与右冠状动脉病变在总体组（35% vs 18%，p=0.009）、支架组（44% vs 13%，p=0.008）和旋切术组（35% vs 22%，p=0.10）中的再狭窄率分别显著更高。多变量分析表明，根据二元（直径狭窄>50%）和连续（晚期狭窄百分比）定义，术后管腔直径（p=0.03，p=0.009）和冠状动脉位置（所治疗的左前降支血管比例，p=0.002，p<0.001），而非器械类型（支架与旋切术），是再狭窄的强有力独立决定因素。（摘要截断于250字）
