Goto T, Mitsudo K, Matsunaga K, Doi O, Nishihara Y, Awa J, Hase T, Sakamoto T, Toda M, Kou E
Department of Cardiology, Kurashiki Central Hospital.
J Cardiol. 1989 Jun;19(2):375-85.
Percutaneous transluminal coronary angioplasty (PTCA) was evaluated as a means of reperfusion of the infarct-related coronary artery, and the results were compared with those of percutaneous transluminal coronary recanalization (PTCR). There were no difference in sex, age, infarct location and time from the onset to start of treatment between 135 patients with evolving acute myocardial infarction treated with PTCA (PTCA group) and 113 patients treated with PTCR alone (PTCR group). Fifty-nine patients in the PTCA group underwent PTCA following PTCR; the remaining 76 patients were without prior PTCR. Successful PTCA, defined as a 20% or more reduction in percent luminal stenosis diameter, was achieved in 123 (90%) of the 135 patients in the PTCA group. The reperfusion rate was 93% in the PTCA group and 77% in the PTCR group (p less than 0.01). Residual stenosis immediately after the treatment was 30 +/- 13% in the PTCA group and 70 +/- 16% in the PTCR group (p less than 0.01). In the PTCA group, three cases developed serious complications which were associated with angioplasty: coronary perforation, side branch occlusion resulting in cardiogenic shock and exacerbation of cardiogenic shock. The latter two patients died, however, there was no difference in hospital mortality rate: 6% in the PTCA group versus 11% in the PTCR group. At follow-up angiography performed four weeks after admission, reocclusion of the successfully recanalized arteries was observed in 3% of the PTCA group and in 14% of the PTCR group (p less than 0.01). Regional wall motion was evaluated by left ventriculography using a wall motion score system which consisted of six grades; from normal counted as 0, to dyskinesis counted as 5. There was no difference in the wall motion score between the successful PTCA group and the successful PTCR group (2.6 +/- 1.4 versus 2.8 +/- 1.4), but the scores of both groups were better than those of the non-recanalized group (3.4 +/- 1.0: p less than 0.01). In conclusion, PTCA and PTCR have the same effect on hospital mortality rate and regional wall motion, but PTCA has a higher reperfusion rate and a lower reocclusion rate than does PTCR. Although PTCA has a potential disadvantage inducing serious complications, it appears to be a useful treatment for acute myocardial infarction.
经皮腔内冠状动脉成形术（PTCA）作为梗死相关冠状动脉再灌注的一种手段进行了评估，并将结果与经皮腔内冠状动脉再通术（PTCR）的结果进行了比较。接受PTCA治疗的135例进展性急性心肌梗死患者（PTCA组）和仅接受PTCR治疗的113例患者（PTCR组）在性别、年龄、梗死部位以及从发病到开始治疗的时间方面没有差异。PTCA组的59例患者在PTCR后接受了PTCA；其余76例患者未接受过PTCR。PTCA组135例患者中有123例（90%）成功进行了PTCA，定义为管腔狭窄直径百分比降低20%或更多。PTCA组的再灌注率为93%，PTCR组为77%（p<0.01）。治疗后即刻PTCA组的残余狭窄为30±13%，PTCR组为70±16%（p<0.01）。在PTCA组，有3例发生了与血管成形术相关的严重并发症：冠状动脉穿孔、侧支闭塞导致心源性休克以及心源性休克加重。后两名患者死亡，然而，两组的住院死亡率没有差异：PTCA组为6%，PTCR组为11%。在入院四周后进行的随访血管造影中，PTCA组3%的成功再通动脉出现再闭塞，PTCR组为14%（p<0.01）。使用由六个等级组成的壁运动评分系统通过左心室造影评估局部壁运动；从正常计为0到运动障碍计为5。成功PTCA组和成功PTCR组之间的壁运动评分没有差异（2.6±1.4对2.8±1.4），但两组的评分均优于未再通组（3.4±1.0：p<0.01）。总之，PTCA和PTCR对住院死亡率和局部壁运动有相同的影响，但PTCA比PTCR有更高的再灌注率和更低的再闭塞率。尽管PTCA有导致严重并发症的潜在缺点，但它似乎是急性心肌梗死的一种有效治疗方法。
