Weintraub W S, Ghazzal Z M, Douglas J S, Liberman H, Morris D C, Cohen C L, King S B
Andreas Gruentzig Cardiovascular Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Am J Cardiol. 1992 Jul 1;70(1):47-55. doi: 10.1016/0002-9149(92)91388-k.
Restenosis remains a critical limitation after percutaneous transluminal coronary angioplasty (PTCA). The clinical experience with restenosis was reviewed in 1,490 patients who had restenosis of at least 1 site within 1 year of their PTCA. The source of data was the clinical database at Emory University. Patients who had previous coronary bypass surgery or PTCA and patients who underwent PTCA in the setting of acute myocardial infarction were excluded. When restenosis was angiographically documented, 363 were treated medically, 1,051 with repeat PTCA, and 76 with coronary bypass surgery. In the repeat PTCA group there were 778 patients who originally had 1-vessel disease and 273 with multiple vessel disease. Re-dilatation of restenotic sites was performed in 95%. Angiographic success of all lesions dilated was achieved in 99%. Coronary bypass surgery was required in 2.5% of patients with restenosis first treated with repeat PTCA. One patient with multiple vessel disease died. Coronary bypass surgery was performed in fewer patients aged greater than or equal to 65 years, but more patients with multiple vessel disease. Two (2.6%) of the coronary bypass surgery patients had Q-wave myocardial infarction and there were no deaths. In the PTCA group, 5-year actuarial survival was 95%, and cardiac survival 96%. Freedom from cardiac events or further revascularization procedures was 51% at 5 years. Patients treated with PTCA and medically treated patients had similar cardiac survival rates. The most important correlates of cardiac survival were age and the presence of diabetes mellitus. At 5 years, cardiac survival without diabetes was 97 and 83% with diabetes (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
经皮腔内冠状动脉成形术（PTCA）后再狭窄仍是一个关键限制因素。回顾了1490例PTCA术后1年内至少有1处再狭窄患者的再狭窄临床经验。数据来源是埃默里大学的临床数据库。排除既往有冠状动脉搭桥手术或PTCA史的患者以及在急性心肌梗死情况下接受PTCA的患者。血管造影记录到再狭窄时，363例接受药物治疗，1051例接受再次PTCA，76例接受冠状动脉搭桥手术。在再次PTCA组中，778例患者最初为单支血管病变，273例为多支血管病变。95%的患者对再狭窄部位进行了再次扩张。所有扩张病变的血管造影成功率达到99%。首次接受再次PTCA治疗的再狭窄患者中，2.5%需要冠状动脉搭桥手术。1例多支血管病变患者死亡。年龄大于或等于65岁的患者接受冠状动脉搭桥手术的较少，但多支血管病变患者较多。冠状动脉搭桥手术患者中有2例（2.6%）发生Q波心肌梗死，无死亡病例。在PTCA组中，5年精算生存率为95%，心脏生存率为96%。5年时无心脏事件或进一步血运重建手术的比例为51%。接受PTCA治疗的患者和接受药物治疗的患者心脏生存率相似。心脏生存的最重要相关因素是年龄和糖尿病的存在。5年时，无糖尿病患者的心脏生存率为97%，有糖尿病患者为83%（p<0.0001）。（摘要截断于250字）
