Alfonso F, Macaya C, Iñiguez A, Hernández R A, Ferrero J, Herrero C, Fernández-Ortiz A, Casado J, Zarco P
Departamento de Cardiopulmonar, Hospital Clínico Universitario, Madrid.
Rev Esp Cardiol. 1991 Apr;44(4):241-50.
Previous studies have suggested that the results of coronary angioplasty are poorer when the attempted lesion has a thrombus associated. With the aim of assessing the results of coronary angioplasty in lesions with thrombus, 1,192 consecutive coronary lesions attempted were prospectively analyzed. Of these, 88 (7%) had associated an angiographic intraluminal filling defect consistent with thrombus (group I) and were compared with the remaining 1,104 lesions (93%) without thrombus (group II). Age (56 +/- 12 vs 59 +/- 10 years) was similar in both groups, but patients in group I required more frequently dilatation after a myocardial infarction (acute phase or following thrombolytic therapy) (36% vs 12%, p less than 0.005) but infrequently for stable angina (6% vs 21%, p less than 0.005). Left ventricular ejection fraction (60 +/- 13% vs 63 +/- 12%) and the number of diseased vessels (1.46 +/- 0.7 vs 1.58 +/- 0.8) were similar in groups I and II, respectively, but lesions in group I were less frequently located in the left anterior descending coronary artery (35% vs 53%, p less than 0.025). Furthermore, lesions in group I were more frequently total occlusions (35% vs 4%, p less than 0.001), and were more severe (94 +/- 6% vs 87 +/- 8%, p less than 0.005), eccentric (81% vs 54%, p less than 0.005), irregular (72% vs 32%, p less than 0.005) and more frequently located at bend points (31% vs 17%, p less than 0.05). Primary angiographic success was lower in group I (79% vs 92%, p less than 0.001) and, after dilatation, the incidence of luminal irregularities (34% vs 15%, p less than 0.001) and early reocclusion (10% vs 1%, p less than 0.05) was higher in this group. However, when patients presenting with total occlusions were excluded from both groups primary angiographic success was similar (90% vs 91%) for groups I and II, respectively. We conclude that: 1) Lesions with intracoronary thrombus usually present other unfavourable angiographic characteristics for dilatation. 2) Results of coronary angioplasty in lesions with thrombus are similar to those obtained in other lesions when totally occluded vessels are excluded.
既往研究提示，当试图处理的病变伴有血栓时，冠状动脉血管成形术的结果较差。为了评估伴有血栓的冠状动脉病变行血管成形术的结果，我们对连续尝试处理的1192处冠状动脉病变进行了前瞻性分析。其中，88处（7%）伴有与血栓一致的血管造影腔内充盈缺损（I组），并与其余1104处无血栓的病变（93%，II组）进行比较。两组年龄相似（56±12岁 vs 59±10岁），但I组患者更常在心肌梗死（急性期或溶栓治疗后）后需要扩张（36% vs 12%，p<0.005），而因稳定型心绞痛需要扩张的情况较少（6% vs 21%，p<0.005）。I组和II组的左心室射血分数分别为（60±13% vs 63±12%）和病变血管数量（1.46±0.7 vs 1.58±0.8）相似，但I组病变较少位于左前降支冠状动脉（35% vs 53%，p<0.025）。此外，I组病变更常为完全闭塞（35% vs 4%，p<0.001），且更严重（94±6% vs 87±8%，p<0.005）、偏心（81% vs 54%，p<0.005）、不规则（72% vs 32%，p<0.005），且更常位于弯曲点（31% vs 17%，p<0.05）。I组的初次血管造影成功率较低（79% vs 92%，p<0.001），扩张后，该组管腔不规则发生率（34% vs 15%，p<0.001）和早期再闭塞发生率（10% vs 1%，p<0.05）较高。然而，当两组均排除完全闭塞病变的患者时，I组和II组的初次血管造影成功率相似（分别为90% vs 91%）。我们得出结论：1）冠状动脉内有血栓的病变通常具有其他不利于扩张的血管造影特征。2）当排除完全闭塞血管时，伴有血栓的冠状动脉病变行血管成形术的结果与其他病变相似。
