Finci L, von Segesser L, Meier B, De Bruyne B, Anastassiou I, Steffenino G D, Velebit V, Righetti A, Moret P, Faidutti B
Cardiology Center, University Hospital, Geneva, Switzerland.
Circulation. 1987 Nov;76(5 Pt 2):V1-5.
To evaluate medium-term clinical results of two major methods of myocardial revascularization, we compared 80 consecutive patients with multivessel percutaneous transluminal coronary angioplasty (PTCA) with 80 consecutive patients with coronary surgery using both internal mammary arteries in all and additional venous grafts in some. Patients in the surgical group had a higher extent of coronary artery disease. In patients with PTCA a mean of 2.2 vessels per patient were attempted, and in patients with surgery 2.7 distal anastomoses per patient were performed. Primary success for PTCA and surgery was 86% vs 94% and complications occurred in 7% vs 6%, respectively. Control angiograms, done in 86% of patients (59/69) after successful PTCA, showed a recurrence in 42% (25/59). Repeat PTCA was done in 15, elective surgery in seven, and a medical treatment was pursued in 3% patients with restenosis. Recurrence of symptoms after successful surgery was found in three patients (4%). They were treated with PTCA. Clinical follow-up was available for all patients, at a mean of 12 +/- 6 months after PTCA and 16 +/- 9 months after surgery. Mean improvement was 1.5 NYHA functional classes after successful PTCA and 2.1 after surgery; 60% (48/80) vs 89% (48/80), respectively, were in class I (p less than .0001). There were fewer PTCA patients than surgical patients without antianginal drugs at follow-up (19% [11/58] vs 37% [18/48]; p less than .05), and their double product during exercise testing was inferior (272 +/- 56 vs 295 +/- 47 mm Hg X beats/min/100; p less than .05). Medium-term clinical outcome appears better after successful surgery with both internal mammary arteries than after successful multivessel PTCA.
为评估两种主要心肌血运重建方法的中期临床效果，我们将80例连续接受多支血管经皮腔内冠状动脉成形术（PTCA）的患者与80例连续接受冠状动脉手术的患者进行了比较，后者均使用了双侧乳内动脉，部分患者还使用了额外的静脉移植物。手术组患者的冠状动脉疾病范围更广。PTCA组患者平均每例尝试处理2.2支血管，手术组患者平均每例进行2.7处远端吻合。PTCA和手术的初次成功率分别为86%和94%，并发症发生率分别为7%和6%。86%（59/69）成功接受PTCA的患者进行了对照血管造影，其中42%（25/59）出现复发。15例患者进行了再次PTCA，7例患者接受了择期手术，3%的再狭窄患者接受了药物治疗。成功手术后有3例患者（4%）出现症状复发，他们接受了PTCA治疗。所有患者均有临床随访，PTCA术后平均随访时间为12±6个月，手术后平均随访时间为16±9个月。成功接受PTCA后平均纽约心脏协会（NYHA）心功能分级改善1.5级，手术后改善2.1级；分别有60%（48/80）和89%（48/80）的患者达到I级（p<0.0001）。随访时，未使用抗心绞痛药物的PTCA患者少于手术患者（19%[11/58]对37%[18/48]；p<0.05），且他们运动试验中的双乘积较低（272±56对295±47mmHg×次/分钟/100；p<0.05）。使用双侧乳内动脉成功手术后的中期临床结果似乎优于成功的多支血管PTCA术后的结果。
