Hartzler G O, Rutherford B D, McConahay D R, Johnson W L, Giorgi L V
Medical Plaza II-20, Kansas City, Missouri 6411.
Am J Cardiol. 1988 May 9;61(14):33G-37G. doi: 10.1016/s0002-9149(88)80030-4.
Of 6,500 percutaneous transluminal coronary angioplasty procedures performed between June 1980 and June 1987, 3,501 (1,604 single lesion and 1,897 multiple lesion) were performed in "low-risk" patients with a procedure-related mortality of 0.2 to 0.3%. In comparison, several clinical variables were identified that increased procedural risk by up to 50-fold. These factors include left main dilatation (n = 103, mortality 3.9%), left main equivalent dilatation (n = 77, mortality 2.6%), ejection fraction less than or equal to 40% (n = 664, mortality 2.7%), age greater than or equal to 70 years (n = 1,038, mortality 1.4%), dilatation of all 3 vessels (n = 305, mortality 1.3%), combined diagnostic catheterization and angioplasty for unstable angina (n = 193, mortality 1.5%), and percutaneous transluminal coronary angioplasty for acute myocardial infarction (n = 446, mortality 8.5%). Important considerations in the selection and management of these high-risk patients are discussed.
在1980年6月至1987年6月间进行的6500例经皮腔内冠状动脉成形术（PTCA）中，3501例（其中单处病变1604例，多处病变1897例）是在“低风险”患者中进行的，手术相关死亡率为0.2%至0.3%。相比之下，确定了几个可将手术风险提高多达50倍的临床变量。这些因素包括左主干扩张（103例，死亡率3.9%）、左主干等同病变扩张（77例，死亡率2.6%）、射血分数小于或等于40%（664例，死亡率2.7%）、年龄大于或等于70岁（1038例，死亡率1.4%）、三支血管均扩张（305例，死亡率1.3%）、不稳定型心绞痛联合诊断性心导管检查和血管成形术（193例，死亡率1.5%）以及急性心肌梗死的经皮腔内冠状动脉成形术（446例，死亡率8.5%）。本文讨论了这些高危患者选择和管理中的重要注意事项。
