Jaski B E, Cohen J D, Trausch J, Marsh D G, Bail G R, Overlie P A, Skowronski E W, Smith S C
San Diego Cardiac Center, CA 92123.
Am Heart J. 1992 Dec;124(6):1427-33. doi: 10.1016/0002-8703(92)90053-x.
Despite recent clinical trials of percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction, specific groups of patients that may benefit from adjunctive or alternative therapy have yet to be adequately characterized. The in-hospital outcome of 151 consecutive patients treated for acute myocardial infarction with urgent PTCA of the infarct-related artery was studied to identify a subgroup of patients at high risk. Patients were divided into two groups based on the angiographic presence of either single-vessel (n = 86) or multivessel (n = 65) coronary artery disease. Despite PTCA of only the infarct-related artery and similar baseline clinical characteristics such as age, peak serum creatine kinase concentration, left ventricular ejection fraction, and time from the onset of chest pain to arrival at the hospital, the group with multivessel disease had a lower rate of successful angioplasty (75% vs 92%, p < 0.005), with higher incidences of persistent total occlusion of the infarct-related artery (14% vs 3%, p < 0.02) and procedural complications during PTCA (28% vs 13%, p < or = 0.02), and were more likely to have multiple complications (12% vs 1%, p < 0.004). In addition, the group with multivessel disease had a higher rate of urgent (< or = 24 hours) coronary artery bypass graft surgery (13% vs 2%, p < 0.05) and a trend toward a higher in-hospital mortality rate (6% vs 1%, p < or = 0.17). By stepwise logistic regression, only the presence of single-vessel versus multivessel disease was predictive of PTCA success (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
尽管最近有关于经皮腔内冠状动脉成形术（PTCA）治疗急性心肌梗死的临床试验，但可能从辅助或替代治疗中获益的特定患者群体尚未得到充分描述。对151例因急性心肌梗死接受梗死相关动脉紧急PTCA治疗的连续患者的院内结局进行研究，以确定高危患者亚组。根据单支血管（n = 86）或多支血管（n = 65）冠状动脉疾病的血管造影表现将患者分为两组。尽管仅对梗死相关动脉进行了PTCA，且年龄、血清肌酸激酶峰值浓度、左心室射血分数以及胸痛发作至入院时间等基线临床特征相似，但多支血管疾病组的血管成形术成功率较低（75%对92%，p < 0.005），梗死相关动脉持续完全闭塞的发生率较高（14%对3%，p < 0.02），PTCA期间的手术并发症发生率较高（28%对13%，p ≤ 0.02），且更有可能出现多种并发症（12%对1%，p < 0.004）。此外，多支血管疾病组的紧急（≤24小时）冠状动脉旁路移植手术率较高（13%对2%，p < 0.05），且院内死亡率有升高趋势（6%对1%，p ≤ 0.17）。通过逐步逻辑回归分析，只有单支血管与多支血管疾病的存在可预测PTCA成功（p < 0.005）。（摘要截断于250字）
