Webb J G, Myler R K, Shaw R E, Anwar A, Stertzer S H
Coronary Care Unit, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
J Am Coll Cardiol. 1990 Dec;16(7):1569-74. doi: 10.1016/0735-1097(90)90302-6.
The initial and late outcome of coronary angioplasty was studied in 148 patients less than 40 years of age (mean 36.4 +/- 3). Angioplasty was performed on a single vessel in 70% of patients and on multiple vessels in 30%; it was performed on a totally occluded vessel in 20%. Angioplasty was successful in 90.5% of patients, unsuccessful but uncomplicated in 7.4% and complicated by myocardial infarction in 0.7%, emergency bypass surgery in 0.7% and death in 0.7%. At late (mean 3.7 +/- 3 years; range 0.5 to 11.5) follow-up study after successful angioplasty, 94% of patients were alive, 79% were free of angina and 85% had returned to work; late myocardial infarction occurred in 4%. Actuarial survival at 5 years was 95%, and 85% of patients were free from death, infarction or bypass surgery. A second angioplasty was performed in 29 patients (22%) (mean 6.1 +/- 8.4 months) and was successful in 27 (93%), with no deaths. Elective coronary bypass surgery was performed in 8.5% of patients, with perioperative infarction in 9% and no deaths. By univariate analysis, late death was more likely to occur in hypertensive patients (15% versus 2.5%; p less than 0.01) and diabetic patients (21.4% versus 3.6%; p less than 0.01). Cox proportional hazard regression analysis identified hypertension (p = 0.007) and diabetes (p = 0.04) as independent time-related predictors of subsequent death. Thus, early and late results after coronary angioplasty in young adults are favorable, but certain risk factors are important predictors of outcome. Late revascularization procedures (repeat angioplasty or surgery) for restenosis or disease progression are common.
对148例年龄小于40岁（平均36.4±3岁）的患者进行了冠状动脉血管成形术的早期和晚期结果研究。70%的患者对单支血管进行了血管成形术，30%对多支血管进行了血管成形术；20%对完全闭塞的血管进行了血管成形术。血管成形术在90.5%的患者中成功，在7.4%的患者中不成功但无并发症，在0.7%的患者中并发心肌梗死，在0.7%的患者中进行了急诊搭桥手术，在0.7%的患者中死亡。在成功进行血管成形术后的晚期（平均3.7±3年；范围0.5至11.5年）随访研究中，94%的患者存活，79%的患者无心绞痛，85%的患者已恢复工作；晚期心肌梗死发生率为4%。5年的精算生存率为95%，85%的患者无死亡、梗死或搭桥手术。29例患者（22%）进行了第二次血管成形术（平均6.1±8.4个月），其中27例（93%）成功，无死亡。8.5%的患者进行了择期冠状动脉搭桥手术，围手术期梗死发生率为9%，无死亡。单因素分析显示，高血压患者（15%对2.5%；p<0.01）和糖尿病患者（21.4%对3.6%；p<0.01）更易发生晚期死亡。Cox比例风险回归分析确定高血压（p = 0.007）和糖尿病（p = 0.04）是随后死亡的独立时间相关预测因素。因此，年轻成人冠状动脉血管成形术的早期和晚期结果良好，但某些危险因素是结果的重要预测因素。因再狭窄或疾病进展而进行的晚期血运重建手术（重复血管成形术或手术）很常见。
