Tohma M, Yamaguchi T
Center for Cardiovascular Disease, Mitsui Memorial Hospital, Tokyo.
J Cardiol. 1991;21(1):43-52.
To determine the risk factors for restenosis, 170 patients with 245 stenotic lesions who underwent follow-up coronary angiography after successful coronary angioplasty (PTCA) were evaluated. The mean angiographic follow-up period was 116 +/- 39 days (+/- SD). Restenosis was defined according to 3 criteria: 1) greater than or equal to 50% loss of the gain achieved by PTCA, 2) greater than or equal to 60% stenosis at follow-up, 3) greater than or equal to 30% increase in stenosis from post-PTCA. The rate of restenosis was 41.2% by criterion 1), 32.2% by criterion 2) and 34.3% by criterion 3). By univariate analysis of 12 clinical, 9 angiographic and 8 procedural factors, 6 factors were significantly associated with restenosis: 1) left anterior descending artery, 2) severe stenosis before PTCA, 3) long lesions, 4) calcified lesions, 5) maximal inflation pressure greater than or equal to 100 psi, 6) number of inflations greater than or equal to 6 times. No clinical factors were suggested to have significant influence on restenosis. Multivariate analysis (stepwise method) revealed independent 6 factors related to restenosis in the following order of importance: 1) number of inflations, 2) maximal inflation pressure, 3) presence of calcification, 4) vessel dilated at PTCA, 5) diabetes mellitus, 6) lesion length. The residual stenosis had no significant influence on restenosis. This may have been due to a small number (14.7%, 36 lesions) of prominent residual stenoses (greater than or equal to 40%) in this study. The presence or absence of intimal disruptions had no significant influence on restenosis. It was suggested that restenosis after successful PTCA may be influenced mainly by "local factors" related to regions.
为确定再狭窄的危险因素,对170例患有245处狭窄病变且在成功进行冠状动脉血管成形术(PTCA)后接受了冠状动脉造影随访的患者进行了评估。血管造影的平均随访期为116±39天(±标准差)。再狭窄根据3项标准定义:1)PTCA所获增益丧失大于或等于50%;2)随访时狭窄大于或等于60%;3)自PTCA后狭窄增加大于或等于30%。根据标准1),再狭窄率为41.2%;根据标准2),为32.2%;根据标准3),为34.3%。通过对12项临床因素、9项血管造影因素和8项操作因素进行单因素分析,有6项因素与再狭窄显著相关:1)左前降支;2)PTCA前严重狭窄;3)长病变;4)钙化病变;5)最大充盈压力大于或等于100磅力/平方英寸;6)充盈次数大于或等于6次。未发现临床因素对再狭窄有显著影响。多因素分析(逐步法)显示与再狭窄相关的独立6项因素按重要性顺序如下:1)充盈次数;2)最大充盈压力;3)钙化的存在;4)PTCA时扩张的血管;5)糖尿病;6)病变长度。残余狭窄对再狭窄无显著影响。这可能是由于本研究中突出的残余狭窄(大于或等于40%)数量较少(14.7%,36处病变)。内膜撕裂的有无对再狭窄无显著影响。提示成功PTCA后的再狭窄可能主要受与病变部位相关的“局部因素”影响。