Webb J G, Myler R K, Shaw R E, Anwar A, Murphy M C, Mooney J F, Mooney M R, Stertzer S H
San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.
J Am Coll Cardiol. 1990 Jul;16(1):57-65. doi: 10.1016/0735-1097(90)90456-y.
Between March 1978 and July 1981, 217 symptomatic patients underwent coronary angioplasty as an alternative to coronary bypass surgery. Angioplasty was successful in 143 patients (66%), unsuccessful but uncomplicated in 65 (30%) and complicated in 9 (4%) by one or more of the following criteria: Q wave myocardial infarction (2%), emergency surgery (4%) or death (0.5%). Late follow-up evaluation was obtained in 213 patients at a mean of 9 +/- 1 years. Of patients in whom angioplasty was successful, 59 (42%) of 140 required another revascularization procedure (repeat angioplasty in 26% and bypass surgery in 16%). The actuarial survival rate at 5, 9 and 10 years after successful angioplasty was 98%, 93% and 92%, respectively. Of the 65 patients with unsuccessful and uncomplicated angioplasty (usually as a result of technical factors), 58 underwent elective bypass surgery within 2 months and 56 survived. These 56 surgical patients were compared with the 140 patients with successful angioplasty. Univariate analysis of prognostic factors did not reveal significant differences between these two groups. At late follow-up study, the successful angioplasty and the successful surgical groups had similar rates of survival (93% versus 95%, p = NS) and of death or infarction, or both (11% versus 12.5%, p = NS). Repeat revascularization was required more frequently after successful angioplasty than after surgery (42% versus 18%, p less than 0.001). Crossover from angioplasty to surgery occurred slightly more often than from surgery to angioplasty (16% versus 12.5%, p = NS). The time to crossover from angioplasty to surgery occurred earlier than from surgery to angioplasty (mean 21 versus 76 months, p less than 0.001).
1978年3月至1981年7月期间，217例有症状的患者接受了冠状动脉成形术，作为冠状动脉搭桥手术的替代方案。143例患者（66%）冠状动脉成形术成功，65例（30%）不成功但未出现并发症，9例（4%）出现一种或多种以下情况的并发症：Q波心肌梗死（2%）、急诊手术（4%）或死亡（0.5%）。213例患者获得了平均9±1年的后期随访评估。在冠状动脉成形术成功的患者中，140例中有59例（42%）需要再次进行血运重建手术（26%为重复冠状动脉成形术，16%为搭桥手术）。冠状动脉成形术成功后5年、9年和10年的精算生存率分别为98%、93%和92%。在65例冠状动脉成形术不成功但未出现并发症的患者中（通常由于技术因素），58例在2个月内接受了择期搭桥手术，56例存活。将这56例手术患者与140例冠状动脉成形术成功的患者进行比较。对预后因素的单因素分析未显示这两组之间存在显著差异。在后期随访研究中，冠状动脉成形术成功组和手术成功组的生存率（93%对95%，p=无显著性差异）以及死亡或梗死发生率，或两者发生率（11%对12.5%，p=无显著性差异）相似。冠状动脉成形术成功后比手术后更频繁地需要再次进行血运重建手术（42%对18%，p<0.001）。从冠状动脉成形术转为手术的情况比从手术转为冠状动脉成形术的情况略多（16%对12.5%，p=无显著性差异）。从冠状动脉成形术转为手术的时间比从手术转为冠状动脉成形术的时间更早（平均21个月对76个月，p<0.001）。
