Laskey M A, Deutsch E, Barnathan E, Laskey W K
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia.
Am J Cardiol. 1990 Jun 15;65(22):1425-9. doi: 10.1016/0002-9149(90)91348-a.
The acute procedural outcome of percutaneous transluminal coronary angioplasty in 304 patients with unstable angina was retrospectively examined with respect to the influence of prolonged preprocedural intravenous heparin therapy. Clinical and angiographic success in 135 patients receiving heparin therapy for greater than or equal to 24 hours was 91% while such success was noted in 81% of patients not treated with heparin (p = 0.02). The incidence of immediate postprocedural thrombotic vessel occlusion was higher in the nonheparin group than in the heparin-treated group (8.3 vs 1.5%, respectively, p less than 0.01). In addition, the overall rate of thromboembolic target and branch or distal vessel occlusion was 12.4% in the nonheparin group and 1.5% in the heparin-treated group (p less than 0.001). Thus, prolonged preprocedural intravenous heparin administration in this well-defined group of patients with unstable angina resulted in an improved procedural success rate and a significant decrease in the risk of abrupt vessel closure. These observations are concordant with current understanding of the pathophysiology of unstable angina.
回顾性研究了304例不稳定型心绞痛患者经皮腔内冠状动脉成形术的急性手术结果，以探讨术前延长静脉肝素治疗的影响。135例接受肝素治疗≥24小时患者的临床和血管造影成功率为91%，而未接受肝素治疗患者的成功率为81%（p = 0.02）。非肝素组术后即刻血栓形成性血管闭塞的发生率高于肝素治疗组（分别为8.3%和1.5%，p<0.01）。此外，非肝素组血栓栓塞性靶血管及分支或远端血管闭塞的总发生率为12.4%，肝素治疗组为1.5%（p<0.001）。因此，在这组明确的不稳定型心绞痛患者中，术前延长静脉肝素给药可提高手术成功率，并显著降低血管突然闭塞的风险。这些观察结果与目前对不稳定型心绞痛病理生理学的认识一致。
