Stevens T, Kahn J K, McCallister B D, Ligon R W, Spaude S, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V, Shimshak T M
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Am J Cardiol. 1991 Aug 1;68(4):313-9. doi: 10.1016/0002-9149(91)90825-6.
The risks and long-term outcome after 845 elective percutaneous transluminal coronary angioplasties (PTCA) in patients with left ventricular (LV) dysfunction (ejection fraction less than or equal to 40%) were examined. Procedural results were compared with 8,117 consecutive procedures in patients with ejection fractions greater than 40%. The patients with LV dysfunction were older (63 vs 60 years, p less than 0.01), had a greater incidence of prior myocardial infarction (84 vs 45%, p less than 0.001), prior bypass surgery (39 vs 21%, p less than 0.001), 3-vessel disease (62 vs 33%, p less than 0.001), and class IV angina (48 vs 41%, p less than 0.01) than the control group. Angiographic success was lower (93 vs 95%, p less than 0.01), and overall procedural mortality was increased ( 4 vs 1%, p less than 0.001) in the study group. Emergency surgery rates were identical (2%). No significant difference was found in rates of nonfatal Q-wave myocardial infarction (2 vs 1%). At mean follow-up of 33.5 months, 15% of the patients with LV dysfunction required late bypass surgery, 27% underwent repeat PTCA, and 59% were angina free. Actuarial survival at 1 and 4 years was 87 and 69%, respectively. Cox regression analysis identified 3-vessel disease, age greater than or equal to 70 years, class IV angina and incomplete revascularization as correlates of long-term mortality. These data suggest that PTCA may be an effective treatment for coronary artery disease in patients with LV dysfunction.
我们对845例左心室（LV）功能不全（射血分数小于或等于40%）患者进行择期经皮腔内冠状动脉成形术（PTCA）后的风险及长期预后进行了研究。将手术结果与8117例射血分数大于40%的连续手术患者进行了比较。LV功能不全的患者年龄更大（63岁对60岁，p<0.01），既往心肌梗死发生率更高（84%对45%，p<0.001），既往搭桥手术发生率更高（39%对21%，p<0.001），三支血管病变发生率更高（62%对33%，p<0.001），IV级心绞痛发生率更高（48%对41%，p<0.01）。研究组的血管造影成功率较低（93%对95%，p<0.01），总体手术死亡率增加（4%对1%，p<0.001）。急诊手术率相同（2%）。非致命性Q波心肌梗死发生率无显著差异（2%对1%）。平均随访33.5个月时，15%的LV功能不全患者需要晚期搭桥手术，27%接受了重复PTCA，59%无心绞痛症状。1年和4年的精算生存率分别为87%和69%。Cox回归分析确定三支血管病变、年龄大于或等于70岁、IV级心绞痛和血管重建不完全是长期死亡率的相关因素。这些数据表明，PTCA可能是LV功能不全患者冠心病的有效治疗方法。
