Kohli R S, DiSciascio G, Cowley M J, Nath A, Goudreau E, Vetrovec G W
Department of Medicine, Medical College of Virginia, Richmond, 23298.
J Am Coll Cardiol. 1990 Oct;16(4):807-11. doi: 10.1016/s0735-1097(10)80326-2.
The applications for coronary angioplasty have greatly expanded and the procedure is now increasingly used in complex and potentially high risk conditions. This report describes the short- and long-term effects of coronary angioplasty in 61 patients with severely depressed left ventricular function (ejection fraction less than or equal to 35%) with unstable or refractory anginal symptoms, or both, in whom revascularization was necessary despite increased risk. In a retrospective analysis of 1,260 patients undergoing angioplasty between January 1985 through December 1987, 61 had an ejection fraction less than or equal to 35%. The common clinical presentation was unstable angina (70%) with or without recent myocardial infarction. Mean left ventricular ejection fraction was 27 +/- 6%. Forty-five patients (74%) had multivessel disease. Clinical success after angioplasty was achieved in 55 patients (90%). Major complications (death, infarction and emergency bypass surgery) occurred in five patients (8.2%), with death in two (3.2%). During long-term (mean 21 +/- 11 months) follow-up study of the 55 patients with successful angioplasty, 13 (23%) died, including 3 of noncardiac causes, and 11 (20%) had clinically symptomatic recurrence. Continued clinical success was present in 39 patients (71%), of whom 28 (51%) were event-free patients and 11 (20%) had clinical recurrence; a successful second angioplasty procedure was performed in 9 because of restenosis. Thus, in patients with depressed left ventricular function, coronary angioplasty can be performed with a short-term success rate comparable to that of routine angioplasty or surgical procedures. However, acute complications are more frequent and the late mortality rate is higher than in patients with less depressed function.
冠状动脉成形术的应用范围已大幅扩展，目前该手术越来越多地用于复杂且潜在高风险的情况。本报告描述了冠状动脉成形术对61例左心室功能严重减退（射血分数小于或等于35%）、伴有不稳定型或难治性心绞痛症状或两者兼具的患者的短期和长期影响，这些患者尽管风险增加，但仍需要进行血运重建。在对1985年1月至1987年12月期间接受成形术的1260例患者进行的回顾性分析中，61例患者的射血分数小于或等于35%。常见的临床表现为不稳定型心绞痛（70%），伴有或不伴有近期心肌梗死。平均左心室射血分数为27±6%。45例患者（74%）患有多支血管病变。55例患者（90%）在成形术后取得了临床成功。5例患者（8.2%）发生了主要并发症（死亡、梗死和急诊搭桥手术），其中2例死亡（3.2%）。在对55例成形术成功的患者进行的长期（平均21±11个月）随访研究中，13例（23%）死亡，其中3例死于非心脏原因，11例（20%）出现临床症状复发。39例患者（71%）持续取得临床成功，其中28例（51%）为无事件患者，11例（20%）出现临床复发；9例因再狭窄接受了成功的二次成形术。因此，对于左心室功能减退的患者，冠状动脉成形术的短期成功率与常规成形术或外科手术相当。然而，与功能减退较轻的患者相比，急性并发症更常见，晚期死亡率更高。
