Bentivoglio L G, Holubkov R, Kelsey S F, Holmes D R, Sopko G, Cowley M J, Myler R K
Lankenau Hospital, Philadelphia, PA.
Cathet Cardiovasc Diagn. 1991 Aug;23(4):227-38. doi: 10.1002/ccd.1810230402.
In a cohort of 1,720 consecutive patients from the National Heart, Lung, and Blood Institute, Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry (August 1985-May 1986), we compared 768 patients (45%) with stable angina and 952 patients (55%) with unstable angina pectoris. Unstable angina patients exhibited at least one of the following characteristics: new onset angina, rapidly progressing angina, angina at rest, angina refractory to medication, variant angina, acute coronary insufficiency, or angina recurring shortly after an acute myocardial infarct. The distribution of single- and multi-vessel disease was similar among stable and unstable angina patients; multi-vessel disease predominated. Average severity of stenosis and incidence of tubular and diffuse stenosis morphology were higher among patients with unstable angina (both p less than 0.001). Patient success rates were similar in stable and unstable patients. However, on a per lesion basis, overall angiographic success rate and average reduction of severity of stenosis in successfully dilated lesions were significantly higher among patients with unstable angina (both p less than 0.001). Incidence of major patient complications (p less than 0.01) and of emergency coronary bypass surgery (p less than 0.05) were also higher in patients with unstable angina but consistent with their more precarious clinical condition and stenosis morphology. During a two year follow-up, the cumulative distributions of death, myocardial infarct, repeat PTCA, and coronary bypass surgery were not significantly different in patients with stable angina compared to patients with unstable angina. Comparison of the current PTCA Registry cohort with the cases reported in the 1979-1982 Registry revealed a 19% higher success rate for both stable and unstable angina patients. Major complication rates decreased between time periods for stable but not for unstable angina patients. Incidence of emergency bypass surgery decreased more for stable than for unstable angina patients. Coronary angioplasty is indicated in properly selected patients with unstable angina and both single- and multi-vessel coronary disease.
在国立心肺血液研究所经皮腔内冠状动脉成形术（PTCA）注册研究（1985年8月至1986年5月）中连续纳入的1720例患者队列中，我们比较了768例（45%）稳定型心绞痛患者和952例（55%）不稳定型心绞痛患者。不稳定型心绞痛患者表现出以下至少一种特征：新发心绞痛、迅速进展性心绞痛、静息性心绞痛、药物难治性心绞痛、变异型心绞痛、急性冠状动脉供血不足或急性心肌梗死后不久复发的心绞痛。单支血管病变和多支血管病变在稳定型和不稳定型心绞痛患者中的分布相似；多支血管病变为主。不稳定型心绞痛患者的平均狭窄严重程度以及管状和弥漫性狭窄形态的发生率更高（两者p均小于0.001）。稳定型和不稳定型患者的手术成功率相似。然而，以每个病变为基础，不稳定型心绞痛患者的总体血管造影成功率和成功扩张病变的狭窄严重程度平均降低幅度显著更高（两者p均小于0.001）。不稳定型心绞痛患者的主要患者并发症发生率（p小于0.01）和急诊冠状动脉搭桥手术发生率（p小于0.05）也更高，但与其更不稳定的临床状况和狭窄形态相符。在两年的随访期间，稳定型心绞痛患者与不稳定型心绞痛患者相比，死亡、心肌梗死、重复PTCA和冠状动脉搭桥手术的累积分布无显著差异。将当前PTCA注册研究队列与1979 - 1982年注册研究中报告的病例进行比较，发现稳定型和不稳定型心绞痛患者的成功率均高出19%。稳定型心绞痛患者的主要并发症发生率在不同时间段有所下降，但不稳定型心绞痛患者没有。稳定型心绞痛患者急诊搭桥手术的发生率下降幅度大于不稳定型心绞痛患者。对于经适当选择的单支血管和多支血管冠状动脉疾病的不稳定型心绞痛患者，冠状动脉成形术是适用的。
