Huber M S, Mooney J F, Madison J, Mooney M R
Minneapolis Heart Institute/Abbott Northwestern Hospital, Minnesota.
Am J Cardiol. 1991 Aug 15;68(5):467-71. doi: 10.1016/0002-9149(91)90780-o.
To determine if morphology of procedure-associated dissections could help predict clinical outcome, angiograms of 691 coronary artery dissections resulting from percutaneous transluminal coronary angioplasty were categorized according to the National Heart, Lung, and Blood Institute classification system. Classes of dissection were then correlated with clinical outcome: 543 patients with type B dissections had no increase in morbidity and mortality when compared with patients without dissection, with a similar success rate of 93.7%. Complications in this group were low and compared favorably with complication rates in procedures not associated with dissection. One hundred forty-eight procedures associated with dissections of types C to F had a significant increase in in-hospital complications, including acute closure (31%), need for emergency coronary bypass surgery (37%), myocardial infarction (13%) and repeat angioplasty (24%). The overall clinical success rate for those with types C to F dissection was 38%. The differences in clinical success and acute complications between type B and types C to F dissections were statistically significant at p less than 0.0005 for all variables studied. The angiographic morphology of a dissection during coronary angioplasty can predict clinical outcome, aiding in selection of effective therapy.
为了确定与手术相关的夹层形态是否有助于预测临床结果，根据美国国立心肺血液研究所的分类系统，对经皮冠状动脉腔内血管成形术导致的691例冠状动脉夹层的血管造影进行了分类。然后将夹层类别与临床结果相关联：543例B型夹层患者与无夹层患者相比，发病率和死亡率没有增加，成功率相似，为93.7%。该组并发症发生率较低，与无夹层手术的并发症发生率相比更具优势。148例与C至F型夹层相关的手术住院并发症显著增加，包括急性闭塞（31%）、急诊冠状动脉搭桥手术需求（37%）、心肌梗死（13%）和重复血管成形术（24%）。C至F型夹层患者的总体临床成功率为38%。对于所有研究变量，B型与C至F型夹层之间的临床成功率和急性并发症差异在p小于0.0005时具有统计学意义。冠状动脉血管成形术中夹层的血管造影形态可以预测临床结果，有助于选择有效的治疗方法。
