Miller D D, Liu P, Strauss H W, Block P C, Okada R D, Boucher C A
J Am Coll Cardiol. 1987 Aug;10(2):275-83. doi: 10.1016/s0735-1097(87)80008-6.
To develop an approach to predicting adverse events after percutaneous transluminal coronary angioplasty (PTCA), 50 patients had thallium-201 exercise testing within 1 month after successful single vessel coronary angioplasty and were followed up for a mean of 18 months. Adverse events were: 1) clinical events consisting of recurrent angina (17 patients) and myocardial infarction (1 patient); 2) treatment events consisting of repeat coronary angioplasty (10 patients) and coronary bypass surgery (1 patient); and 3) restenosis, defined as a greater than 30% increase in luminal stenosis (15 of 38 recatheterized patients). There were no deaths. Of the clinical, exercise, angiographic and thallium scan variables analyzed by stepwise logistic regression, postangioplasty gradient greater than 20 mm Hg predicted clinical events and treatment events, and the number of segments with slower thallium clearance predicted clinical events, treatment events and restenosis. Using Cox Hazards model regression of survival without events, the number of transient qualitative thallium defects also predicted clinical events and restenosis. At 1 year after angioplasty, 24% of patients with these variables had restenosis compared with only 6% of those without these variables and 36% of patients with these variables had a clinical or treatment event compared with 8% of patients without these variables. Three measures of the adequacy of myocardial perfusion (post-angioplasty gradient, reduced thallium clearance and transient thallium defects) were additive predictors of adverse events after coronary angioplasty with the relative risk being approximately four times greater in patients with these variables than in those without. Such adverse events, therefore, are usually a consequence of inadequate revascularization.
为了开发一种预测经皮腔内冠状动脉成形术（PTCA）后不良事件的方法，50例患者在成功进行单支血管冠状动脉成形术后1个月内进行了铊-201运动试验，并平均随访18个月。不良事件包括：1）临床事件，包括复发性心绞痛（17例患者）和心肌梗死（1例患者）；2）治疗事件，包括重复冠状动脉成形术（10例患者）和冠状动脉搭桥手术（1例患者）；3）再狭窄，定义为管腔狭窄增加超过30%（38例再次导管插入术患者中有15例）。无死亡病例。通过逐步逻辑回归分析的临床、运动、血管造影和铊扫描变量中，血管成形术后梯度大于20 mmHg可预测临床事件和治疗事件，铊清除较慢的节段数可预测临床事件、治疗事件和再狭窄。使用无事件生存的Cox风险模型回归分析，短暂性定性铊缺损的数量也可预测临床事件和再狭窄。血管成形术后1年，有这些变量的患者中24%发生再狭窄，而无这些变量的患者中仅为6%；有这些变量的患者中36%发生临床或治疗事件，而无这些变量的患者中为8%。心肌灌注充足的三个指标（血管成形术后梯度、铊清除减少和短暂性铊缺损）是冠状动脉成形术后不良事件的附加预测因子，有这些变量的患者发生不良事件的相对风险比无这些变量的患者大约大四倍。因此，此类不良事件通常是血管再通不充分的结果。
