Savage M P, Goldberg S, Hirshfeld J W, Bass T A, MacDonald R G, Margolis J R, Taussig A S, Vetrovec G, Whitworth H B, Zalewski A
Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
J Am Coll Cardiol. 1991 Jan;17(1):22-8. doi: 10.1016/0735-1097(91)90700-j.
Clinical and anatomic determinants of the initial success of percutaneous transluminal coronary angioplasty were prospectively evaluated in 826 patients enrolled in the Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART). The 639 men and 187 women ranged in age from 31 to 85 years. Successful angioplasty (residual stenosis less than 50% and no major complications) was achieved in 886 (88.6%) of 1,000 lesions. Success rates were uniform among the eight individual centers. Outcome was not influenced by gender, age or other clinical features, including severity and duration of angina, prior myocardial infarction, rest pain, transient ST segment elevation, history of smoking or diabetes. In contrast, procedural outcome was significantly associated with lesion-specific angiographic factors. Stenoses 60% to 74%, 75% to 89%, 90% to 99% and 100% were associated with success rates of 96%, 90%, 84% and 69%, respectively (p less than 0.001). Angioplasty was less successful in calcified than in noncalcified lesions (82% versus 90%, p less than 0.01), in thrombotic than in nonthrombotic lesions (82% versus 90%, p less than 0.05) and in lesions in the right coronary artery than in other vessels (84% versus 90%, p less than 0.01). Outcome was not related to other anatomic variables, including lesion location (proximal versus distal), vessel size, eccentricity, stenosis length or translesional gradient. By multivariate logistic regression, preangioplasty percent stenosis, right coronary artery location and lesion calcification were demonstrated to be significant independent predictors of angioplasty success. Alternative clinical and angiographic variables did not contribute to this regression model.(ABSTRACT TRUNCATED AT 250 WORDS)
在参与多医院东大西洋再狭窄试验（M - HEART）的826例患者中，前瞻性评估了经皮腔内冠状动脉成形术初始成功的临床和解剖学决定因素。639名男性和187名女性年龄在31至85岁之间。1000处病变中有886处（88.6%）成功进行了血管成形术（残余狭窄小于50%且无重大并发症）。八个独立中心的成功率一致。结果不受性别、年龄或其他临床特征影响，包括心绞痛的严重程度和持续时间、既往心肌梗死、静息痛、短暂ST段抬高、吸烟史或糖尿病史。相比之下，手术结果与病变特异性血管造影因素显著相关。60%至74%、75%至89%、90%至99%和100%的狭窄分别与96%、90%、84%和69%的成功率相关（p小于0.001）。钙化病变的血管成形术成功率低于非钙化病变（82%对90%，p小于0.01），血栓形成病变低于非血栓形成病变（82%对90%，p小于0.05），右冠状动脉病变低于其他血管病变（84%对90%，p小于0.01）。结果与其他解剖学变量无关，包括病变位置（近端与远端）、血管大小、偏心度、狭窄长度或跨病变梯度。通过多因素逻辑回归分析，血管成形术前狭窄百分比、右冠状动脉位置和病变钙化被证明是血管成形术成功的显著独立预测因素。其他临床和血管造影变量对该回归模型无贡献。（摘要截断于250字）
