Goldberg R K, Kleiman N S, Minor S T, Abukhalil J, Raizner A E
Baylor College of Medicine, Houston, TX.
Am Heart J. 1990 Jan;119(1):178-84. doi: 10.1016/s0002-8703(05)80098-5.
Quantitative coronary angiographic measurements and visual estimates of coronary lesion severity were compared prospectively before, immediately following, and 6 months following percutaneous transluminal coronary angioplasty. Mean percent diameter stenosis before angioplasty was 87.9 +/- 9.9% by visual analysis and 64.6 +/- 9.2% by quantitative coronary angiography (p = 0.0001). Differences between these two techniques were also found immediately post-angioplasty (visual analysis 29.5 +/- 11.8%, quantitative coronary angiography 22.8 +/- 11.8%, p = 0.0002) and at 6 months (visual analysis 46.5 +/- 27.4%, quantitative coronary angiography 30.2 +/- 20.4%, p = 0.0001). These differences significantly affected the determination of restenosis by three definitions. (1) Lesion recurrence with greater than or equal to 50% stenosis at follow-up: 38 of 92 (41%) by visual analysis versus 20 of 92 (22%) by quantitative coronary angiography (p less than 0.01). (2) Increase of greater than or equal to 30% stenosis: 34 of 92 (37%) by visual analysis versus 20 of 92 (22%) by quantitative coronary angiography (p less than 0.01). (3) Loss of 50% of previous improvement: 31 of 92 (34%) by visual analysis versus 24 of 92 (26%) by quantitative coronary angiography (p = 0.08). In addition, determination of success or failure of percutaneous transluminal coronary angioplasty was affected by the interpretative technique, but these differences were not statistically significant. We conclude that visual estimates of lesion severity are consistently and significantly higher than quantitative measurements. Consequently, restenosis rates, using currently applied definitions, differ considerably depending on the method of analyzing lesion severity.
对经皮腔内冠状动脉成形术（PTCA）前、术后即刻以及术后6个月的冠状动脉病变严重程度进行了定量冠状动脉造影测量和视觉评估，并进行了前瞻性比较。血管成形术前，通过视觉分析得出的平均直径狭窄百分比为87.9±9.9%，通过定量冠状动脉造影得出的为64.6±9.2%（p = 0.0001）。在血管成形术后即刻也发现了这两种技术之间的差异（视觉分析29.5±11.8%，定量冠状动脉造影22.8±11.8%，p = 0.0002），在6个月时同样存在差异（视觉分析46.5±27.4%，定量冠状动脉造影30.2±20.4%，p = 0.0001）。这些差异显著影响了根据三种定义对再狭窄的判定。（1）随访时狭窄程度≥50%的病变复发：视觉分析92例中有38例（41%），定量冠状动脉造影92例中有20例（22%）（p＜0.01）。（2）狭窄程度增加≥30%：视觉分析92例中有34例（37%），定量冠状动脉造影92例中有20例（22%）（p＜0.01）。（3）丧失先前改善程度的50%：视觉分析92例中有31例（34%），定量冠状动脉造影92例中有24例（26%）（p = 0.08）。此外，经皮腔内冠状动脉成形术成功或失败的判定受解释技术的影响，但这些差异无统计学意义。我们得出结论，病变严重程度的视觉评估始终且显著高于定量测量。因此，根据目前应用的定义，再狭窄率因分析病变严重程度的方法不同而有很大差异。
