Page U S, Okies J E, Colburn L Q, Bigelow J C, Salomon N W, Krause A H
J Thorac Cardiovasc Surg. 1986 Nov;92(5):847-52.
The incidence of prior percutaneous transluminal coronary angioplasty in surgical cases is nearly doubling yearly. In 1985, 11.4% of our bypass patients had one or more prior angioplasties. One hundred thirty-five patients with prior angioplasty are compared to 2,205 patients without angioplasty undergoing surgical revascularization. The mortality is 3.2 times higher in the angioplasty patients than in the control patients and the perioperative infarction rate is 2.5 times higher. Forty-four patients were taken directly to the operating room from the catheterization laboratory, 50 were operated on within 10 days, and 41 underwent operation more than 10 days after angioplasty. All of these late failures were of the lesion previously dilated. The infarction rate was less in patients taken immediately to the operating room on an emergency basis than in those whose operation was delayed up to 10 days (30% versus 70%). All patients who died had angioplasty of the anterior descending coronary artery. Angioplasty of this artery increases operative mortality should surgical treatment become necessary acutely. Patients should be informed before angioplasty of the increased surgical risks after a failed angioplasty procedure.
手术病例中既往经皮腔内冠状动脉成形术的发生率几乎每年都在翻倍。1985年，我们的搭桥手术患者中有11.4%曾接受过一次或多次血管成形术。将135例曾接受过血管成形术的患者与2205例未接受过血管成形术而接受手术血运重建的患者进行比较。血管成形术患者的死亡率比对照组高3.2倍，围手术期梗死率高2.5倍。44例患者从心导管室直接被送往手术室，50例在10天内接受手术，41例在血管成形术后10天以上接受手术。所有这些晚期失败均发生在先前扩张的病变部位。急诊直接送往手术室的患者梗死率低于手术延迟至10天的患者（30%对70%）。所有死亡患者均接受过前降支冠状动脉血管成形术。如果急需进行手术治疗，该动脉的血管成形术会增加手术死亡率。在血管成形术之前，应告知患者血管成形术失败后手术风险会增加。
