Foley J B, Chisholm R J, Common A A, Langer A, Armstrong P W
Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Am Heart J. 1992 Nov;124(5):1174-80. doi: 10.1016/0002-8703(92)90397-e.
The frequency, clinical pattern, and timing of recurrent angina following successful single-lesion percutaneous transluminal coronary angioplasty (PTCA) was assessed in a consecutive group of 104 patients with stable angina and in 85 with unstable angina. In addition, the relationship between lesion morphology and angiographic features and the pattern of recurrent angina was determined. Restenosis, defined as recurrence of symptoms with > 50% stenosis at the site of PTCA, occurred in 25 (24%) of the stable group and in 23 (27%) of the unstable group (p = NS). The pattern of angina at repeat presentation was aggressive in nature in 8% of the stable group and in 48% of the unstable group (p = 0.002). The time interval between the recurrence of symptoms and repeat coronary angiogram or PTCA was longer in the nonaggressive group than in the aggressive group, 16 +/- 12.1 and 5 +/- 6.8 weeks, respectively (p < 0.003). The key factors predicting the recurrent angina pattern identified by multiple logistic regression analysis were the angina status pre-PTCA (p = 0.001) and the presence of double-vessel disease (p = 0.01). An aggressive pattern of angina at the time of restenosis is frequent in patients with unstable angina at the time of PTCA, and close post-PTCA surveillance is necessary in these patients.
对连续入选的104例稳定型心绞痛患者和85例不稳定型心绞痛患者进行评估，以确定成功进行单病变经皮腔内冠状动脉成形术（PTCA）后复发性心绞痛的频率、临床模式和发作时间。此外，还确定了病变形态和血管造影特征与复发性心绞痛模式之间的关系。再狭窄定义为PTCA部位狭窄>50%时症状复发，稳定组25例（24%）出现再狭窄，不稳定组23例（27%）出现再狭窄（p=无显著性差异）。稳定组8%和不稳定组48%的患者再次出现心绞痛时的模式具有侵袭性（p=0.002）。非侵袭性组症状复发与再次冠状动脉造影或PTCA之间的时间间隔比侵袭性组长，分别为16±12.1周和5±6.8周（p<0.003）。多因素logistic回归分析确定的预测复发性心绞痛模式的关键因素是PTCA前的心绞痛状态（p=0.001）和双支血管病变的存在（p=0.01）。PTCA时为不稳定型心绞痛的患者，再狭窄时频繁出现侵袭性心绞痛模式，这些患者术后需要密切监测。
