University of British Columbia, Vancouver Hospital Research Pavilion, 828 W. 10th Avenue, Vancouver, BC, Canada.
Circ Cardiovasc Interv. 2011 Dec 1;4(6):545-52. doi: 10.1161/CIRCINTERVENTIONS.110.960062. Epub 2011 Nov 1.
The extent to which recurrent events in patients with stable coronary artery disease is attributable to progression of an index lesion originally ≥50% diameter stenosis (DS) but not revascularized or originally <50% DS is unknown during optimal medical therapy (OMT).
In the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 205 patients assigned to OMT plus percutaneous coronary intervention (PCI) and 284 patients assigned to OMT only had symptom-driven angiograms suitable for analysis. Percentages of patients in the OMT+PCI and OMT-only cohorts with index lesions originally <50% DS were 30% and 32%, respectively; 20% and 68% had index lesions originally ≥50% DS. In both groups, index lesions originally <50% or ≥50% DS represented <4% and <25% of all such lesions, respectively. The only angiographic predictor of myocardial infarction or acute coronary syndrome was the number of lesions originally ≥50% DS that had not been revascularized (odds ratio, 1.15; confidence limits, 1.01-1.31; P<0.04).
Lesions originally <50% DS were index lesions in one third of patients referred for symptom-driven repeat angiography, but represented <4% of all such lesions. Nonrevascularized lesions originally ≥50% DS were more often index lesions in OMT-only patients, but still represented a minority (<25%) of all such lesions. These findings underscore the need for improved therapies to arrest plaque progression and reliable strategies for selecting stenoses warranting PCI.
在最佳药物治疗（OMT）期间，对于稳定型冠状动脉疾病患者中原本≥50%直径狭窄（DS）但未进行血运重建或原本<50% DS 的病变的复发性事件归因于病变进展的程度尚不清楚。
在 COURAGE（经皮冠状动脉介入治疗和强化药物治疗的临床结果评估）试验中，205 例接受 OMT+经皮冠状动脉介入治疗（PCI）和 284 例接受 OMT 的患者进行了适合分析的症状驱动性血管造影。OMT+PCI 和 OMT 组中原本<50% DS 的病变患者比例分别为 30%和 32%；分别有 20%和 68%的患者有原本≥50% DS 的病变。在这两组中，原本<50%或≥50% DS 的病变分别<4%和<25%。心肌梗死或急性冠状动脉综合征的唯一血管造影预测因素是未进行血运重建的原本≥50% DS 的病变数量（比值比，1.15；置信区间，1.01-1.31；P<0.04）。
在因症状驱动而进行重复血管造影的患者中，原本<50% DS 的病变占三分之一，但仅占所有此类病变的<4%。原本≥50% DS 的未血运重建病变在仅接受 OMT 的患者中更常作为病变，但仍<25%。这些发现强调了需要改善斑块进展的治疗方法和可靠的策略来选择需要 PCI 的狭窄病变。
