Dimas A P, Grigera F, Arora R R, Simpfendorfer C C, Hollman J L, Frierson J H, Franco I, Whitlow P L
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
J Am Coll Cardiol. 1992 May;19(6):1310-4. doi: 10.1016/0735-1097(92)90339-o.
Repeat coronary angioplasty has become the standard approach to a first restenosis. However, the long-term outcome of such a strategy is not well defined. In the present study, 465 patients (mean age 58 years [range 27 to 79], 53% with multivessel disease) underwent a second angioplasty procedure at the same site. The procedure was successful in 96.8% with a 1.5% rate of in-hospital bypass surgery, a 0.9% incidence rate of myocardial infarction and no procedural deaths. Four hundred sixty-three patients (99.6%) were followed up for a mean of 40.5 months. Forty-nine patients (10.6%) underwent a third angioplasty procedure at the same site, 55 (11.8%) had coronary bypass surgery and 33 (7.1%) underwent angioplasty at a different site. During follow-up, 12 patients (2.6%) sustained a myocardial infarction and 21 (4.5%) died including 13 (2.8%) with cardiac death. Of the 442 surviving patients, 88% experienced sustained functional improvement and 78% were free of angina. The actuarial 5-year cardiac survival rate was 96% and the rate of freedom from cardiac death and myocardial infarction was 92%. For the subgroup of 49 patients who had a third angioplasty procedure at the same site, the success rate was 93.9% with a 2% incidence rate of myocardial infarction. There were no in-hospital deaths or coronary artery bypass operations. The mean follow-up interval for this subgroup was 30.5 months with a 22.4% cross-over rate to coronary bypass surgery, a 4.1% incidence rate of myocardial infarction and a 2% cardiac mortality rate. At last follow-up, 89% of patients had sustained functional improvement and 76% were free of angina. The combined angiographic and clinical restenosis rate was 48%. Repeat angioplasty as treatment for restenosis is an effective approach associated with a high success rate, low incidence of procedural complications, and sustained functional improvement in combination with an acceptable rate of bypass surgery. However, there is a trend toward diminished angioplasty efficacy after a second restenosis. Thus, decisions for further revascularization should be made after careful review of available options.
重复冠状动脉血管成形术已成为治疗首次再狭窄的标准方法。然而，这种策略的长期效果尚未明确界定。在本研究中，465例患者（平均年龄58岁[范围27至79岁]，53%患有多支血管病变）在同一部位接受了第二次血管成形术。手术成功率为96.8%，住院期间搭桥手术率为1.5%，心肌梗死发生率为0.9%，无手术死亡病例。463例患者（99.6%）接受了平均40.5个月的随访。49例患者（10.6%）在同一部位接受了第三次血管成形术，55例（11.8%）接受了冠状动脉搭桥手术，33例（7.1%）在不同部位接受了血管成形术。随访期间，12例患者（2.6%）发生心肌梗死，21例（4.5%）死亡，其中13例（2.8%）死于心脏相关原因。在442例存活患者中，88%的患者功能持续改善，78%的患者无心绞痛症状。5年心脏生存率为96%，无心脏死亡和心肌梗死的发生率为92%。对于在同一部位接受第三次血管成形术的49例患者亚组，成功率为93.9%，心肌梗死发生率为2%。无住院死亡或冠状动脉搭桥手术。该亚组的平均随访间隔为30.5个月，冠状动脉搭桥手术的交叉率为22.4%，心肌梗死发生率为4.1%，心脏死亡率为2%。在最后一次随访时，89%的患者功能持续改善，76%的患者无心绞痛症状。血管造影和临床再狭窄的综合发生率为48%。重复血管成形术作为再狭窄的治疗方法是一种有效的方法，成功率高，手术并发症发生率低，功能持续改善，同时搭桥手术率可接受。然而，第二次再狭窄后血管成形术疗效有降低的趋势。因此，在仔细评估现有选择后，应做出进一步血运重建的决策。
