Bourassa M G, Lespérance J, Eastwood C, Schwartz L, Côté G, Kazim F, Hudon G
Department of Medicine, Montreal Heart Institute, Quebec, Canada.
J Am Coll Cardiol. 1991 Aug;18(2):368-76. doi: 10.1016/0735-1097(91)90588-z.
In a recent prospective double-blind placebo-controlled trial, a combination of aspirin and dipyridamole was not associated with a reduction in the rate of restenosis within the 1st 6 months after coronary angioplasty. The purpose of this study was to determine whether clinical, anatomic or procedural factors were predictive of the observed restenosis rates in that prospective trial. A total of 247 patients and 280 segments underwent follow-up angiography and quantitative coronary angiographic analysis between 4 and 7 months after coronary angioplasty. Two baseline clinical characteristics--angina class and duration of angina in months--were related to the rate of restenosis by univariate analysis. Patient-related stepwise logistic regression analysis identified severity of angina as the only clinical predictor of restenosis. Three univariate baseline anatomic characteristics--percent diameter stenosis before angioplasty, stenosis greater than 10 mm in length and calcific stenosis--and two early postangioplasty characteristics--residual percent diameter stenosis and residual mean pressure gradient--were predictive of restenosis. Of these, only two--length of stenosis and residual percent diameter stenosis--were independently related to restenosis by multivariate analysis and only the former is identifiable before the procedure. It is concluded that in prospective studies in contrast to retrospective studies, few clinical and anatomic factors appear to be predictive of restenosis after coronary angioplasty.
在最近一项前瞻性双盲安慰剂对照试验中，阿司匹林和双嘧达莫联合用药与冠状动脉血管成形术后前6个月内再狭窄率的降低无关。本研究的目的是确定在该前瞻性试验中，临床、解剖或手术因素是否可预测观察到的再狭窄率。共有247例患者和280个节段在冠状动脉血管成形术后4至7个月接受了随访血管造影和定量冠状动脉血管造影分析。通过单因素分析，两个基线临床特征——心绞痛分级和心绞痛持续时间（以月为单位）——与再狭窄率相关。患者相关的逐步逻辑回归分析确定心绞痛严重程度是再狭窄的唯一临床预测因素。三个单因素基线解剖特征——血管成形术前直径狭窄百分比、长度大于10 mm的狭窄和钙化性狭窄——以及两个血管成形术后早期特征——残余直径狭窄百分比和残余平均压力梯度——可预测再狭窄。其中，通过多因素分析，只有两个因素——狭窄长度和残余直径狭窄百分比——与再狭窄独立相关，且只有前者在手术前可识别。结论是，与回顾性研究相比，在前瞻性研究中，几乎没有临床和解剖因素似乎可预测冠状动脉血管成形术后的再狭窄。
