Vacek J L, Rosamond T L, Robuck W, Kramer P H, Beauchamp G D
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Cathet Cardiovasc Diagn. 1991 Nov;24(3):161-5. doi: 10.1002/ccd.1810240304.
We studied 417 patients undergoing single vessel culprit lesion percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction to determine the impact of disease in other vessels. Group A (189 patients, 45%) had coronary artery disease (greater than or equal to 70% stenosis) in at least 1 additional vessel while Group B (228 patients, 55%) did not. The groups were similar in sex distribution (A = 75% male, B = 76%), number of lesions in the single culprit vessel dilated (1 lesion in 83% A, 80% B), and PTCA success (A = 92%, B-94%) (all p = NS). Group A patients were older (63 +/- 10 vs. 56 +/- 11 years) and had more prior myocardial infarctions (27% vs. 7%), and more prior coronary artery bypass grafting (15% vs. 0.4%) (all p less than .01). Group A patients were more likely to have repeat catheterization (48% vs. 32%, p less than .005) although restenosis of the infarct-related vessel was similar (A = 24%, B = 16%) (p = NS). Group A was more likely to need angioplasty in a 2nd vessel (23% vs. 8%) and to need coronary artery bypass grafting (20% vs. 8%) (both p less than .001). Cumulative mortality was higher in Group A at 1 month (10% vs. 5%), 1 year (11% vs. 6%), and long-term (13% vs. 7%). This difference appeared to be due to the impact of lower mean ejection fraction in Group A.
Treatment of acute myocardial infarction by direct PTCA of the culprit lesion can be performed with a high likelihood of success in patients with or without multivessel coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
我们研究了417例因急性心肌梗死而接受单支罪犯病变经皮腔内冠状动脉成形术（PTCA）的患者，以确定其他血管病变的影响。A组（189例患者，45%）至少有1支额外血管存在冠状动脉疾病（狭窄大于或等于70%），而B组（228例患者，55%）则没有。两组在性别分布（A组男性占75%，B组男性占76%）、扩张的单支罪犯血管病变数量（A组83%为1处病变，B组80%为1处病变）以及PTCA成功率（A组为92%，B组为94%）方面相似（所有p值均无统计学意义）。A组患者年龄更大（63±10岁对56±11岁），既往心肌梗死更多（27%对7%），既往冠状动脉旁路移植术更多（15%对0.4%）（所有p值均小于0.01）。A组患者更有可能接受再次导管检查（48%对32%，p值小于0.005），尽管梗死相关血管的再狭窄情况相似（A组为24%，B组为16%）（p值无统计学意义）。A组更有可能需要对第二支血管进行血管成形术（23%对8%）以及需要冠状动脉旁路移植术（20%对8%）（两者p值均小于0.001）。A组在1个月时（10%对5%）、1年时（11%对6%）和长期（13%对7%）的累积死亡率更高。这种差异似乎是由于A组较低的平均射血分数的影响。
对罪犯病变进行直接PTCA治疗急性心肌梗死，无论患者有无多支冠状动脉疾病，成功的可能性都很高。（摘要截断于250字）
