Weintraub W S, Ghazzal Z M, Cohen C L, Douglas J S, Liberman H, Morris D C, King S B
Andreas Gruentzig Cardiovascular Center, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Circulation. 1991 Aug;84(2):572-82. doi: 10.1161/01.cir.84.2.572.
The introduction of percutaneous transluminal coronary angioplasty (PTCA) has changed the pattern of intervention in coronary artery disease. However, the long-term results in patients undergoing successful, elective, native-vessel PTCA are not yet fully characterized. Because the healing and subsequent proliferative response after angioplasty are time related, it was the purpose of the present study to determine the long-term outcome in patients whose dilated arteries have been demonstrated to be patent 4-12 months after successful, uncomplicated PTCA.
The patients were grouped on the basis of the 4-12 month catheterization into those whose vessels were angiographically "normal" or had luminal irregularities only at the PTCA sites (396 patients), those whose vessels also had luminal irregularities elsewhere with or without PTCA site luminal irregularities (680 patients), and those with significant obstructive disease (more than 50% diameter narrowing) at sites other than the PTCA sites (426 patients). Of 1,502 such patients, long-term follow-up was available in 1,491. At the time of the original angioplasty, the normal patients had a 1.8% incidence of multivessel disease; luminal irregularity patients, 9.4%; and obstructive disease patients, 58.7%. At angiographic restudy, 16.4% of the obstructive disease patients continued to have multivessel disease. The patients were followed for the events of death, myocardial infarction, coronary surgery, and repeat PTCA. The 6-year survival rate was 95%; cardiac survival, 96%; and freedom from all events, 65%. The strongest correlate of events during follow-up was the angiographic status of the undilated segments. At 6 years, freedom from cardiac events was noted in 77% of the normal group, 61% of the luminal irregularity group, and 55% of the obstructive disease group. Diabetes and hypertension were also independent correlates of events.
Results from the present study show that associated disease in undilated segments is a strong predictor of late events in patients after successful, uncomplicated, reatenosis-free PTCA. However, the need for further revascularization was frequent even in patients without obstructive disease. Completeness of revascularization is appropriate when possible, and limiting progression of coronary disease at sites remote from those dilated should improve on these late results.
经皮腔内冠状动脉成形术（PTCA）的引入改变了冠状动脉疾病的干预模式。然而，成功接受择期、原位血管PTCA的患者的长期结果尚未完全明确。由于血管成形术后的愈合及随后的增殖反应与时间相关，本研究的目的是确定在成功、无并发症的PTCA术后4 - 12个月证实扩张动脉通畅的患者的长期结局。
根据4 - 12个月时的导管检查结果，将患者分为血管造影显示“正常”或仅在PTCA部位有管腔不规则的患者（396例）、血管在其他部位也有管腔不规则且伴有或不伴有PTCA部位管腔不规则的患者（680例）以及在PTCA部位以外有严重阻塞性疾病（直径狭窄超过50%）的患者（426例）。在这1502例患者中，1491例有长期随访资料。在初次血管成形术时，正常患者多支血管病变的发生率为1.8%；管腔不规则患者为9.4%；阻塞性疾病患者为58.7%。在血管造影复查时，16.4%的阻塞性疾病患者仍有多支血管病变。对患者进行死亡、心肌梗死、冠状动脉手术和再次PTCA等事件的随访。6年生存率为95%；心脏相关生存率为96%；无所有事件生存率为65%。随访期间事件的最强相关因素是未扩张节段的血管造影状态。6年时，正常组77%的患者无心脏事件，管腔不规则组为61%，阻塞性疾病组为55%。糖尿病和高血压也是事件的独立相关因素。
本研究结果表明，未扩张节段的相关疾病是成功、无并发症、无再狭窄的PTCA术后患者晚期事件的有力预测因素。然而，即使在无阻塞性疾病的患者中，进一步血管重建的需求也很常见。尽可能实现血管重建的完整性，并限制远离扩张部位的冠状动脉疾病进展，应能改善这些晚期结果。
