Detre K, Holubkov R, Kelsey S, Cowley M, Kent K, Williams D, Myler R, Faxon D, Holmes D, Bourassa M
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15261.
N Engl J Med. 1988 Feb 4;318(5):265-70. doi: 10.1056/NEJM198802043180501.
In August 1985, the Percutaneous Transluminal Coronary Angioplasty Registry of the National Heart, Lung, and Blood Institute reopened at its previous sites to document changes in angioplasty strategy and outcome. The new registry entered 1802 consecutive patients who had not had a myocardial infarction in the 10 days before angioplasty. Patient selection, technical outcome, and short-term major complications were compared with those of the 1977 to 1981 registry cohort. The new-registry patients were older and had a significantly higher proportion of multivessel disease (53 vs. 25 percent, P less than 0.001), poor left ventricular function (19 vs. 8 percent, P less than 0.001), previous myocardial infarction (37 vs. 21 percent, P less than 0.001), and previous coronary bypass surgery (13 vs. 9 percent, P less than 0.01). The new-registry cohort also had more complex coronary lesions, and angioplasty attempts in these patients involved more multivessel procedures. Despite these differences, the in-hospital outcome in the new cohort was better. Angiographic success rates according to lesion increased from 67 to 88 percent (P less than 0.001), and overall success rates (measured as a reduction of at least 20 percent in all lesions attempted, without death, myocardial infarction, or coronary bypass surgery) increased from 61 to 78 percent (P less than 0.001). In-hospital mortality for the new cohort was 1 percent, and the nonfatal myocardial infarction rate was 4.3 percent. Both rates are similar to those for the old registry. The long-term efficacy of current angioplasty remains to be determined.
1985年8月，美国国立心肺血液研究所的经皮腔内冠状动脉成形术登记处重新在其旧址开放，以记录血管成形术策略和结果的变化。新登记处纳入了1802例在血管成形术前10天内未发生心肌梗死的连续患者。将患者的选择、技术结果和短期主要并发症与1977年至1981年登记队列的情况进行了比较。新登记处的患者年龄更大，多支血管病变的比例显著更高（53%对25%，P<0.001），左心室功能较差（19%对8%，P<0.001），既往有心肌梗死（37%对21%，P<0.001），以及既往有冠状动脉搭桥手术（13%对9%，P<0.01）。新登记队列的冠状动脉病变也更复杂，这些患者的血管成形术尝试涉及更多的多支血管手术。尽管存在这些差异，但新队列的院内结局更好。根据病变情况，血管造影成功率从67%提高到了88%（P<0.001），总体成功率（定义为所有尝试病变至少减少20%，且无死亡、心肌梗死或冠状动脉搭桥手术）从61%提高到了78%（P<0.001）。新队列的院内死亡率为1%，非致命性心肌梗死发生率为4.3%。这两个比率与旧登记处的比率相似。目前血管成形术的长期疗效仍有待确定。
