Dorros G, Lewin R F, Mathiak L M
Department of Cardiology St. Luke's Medical Center, Milwaukee, Wisconsin.
Clin Cardiol. 1988 Sep;11(9):601-12. doi: 10.1002/clc.4960110904.
Transluminal coronary angioplasty was successfully performed in 658 of 752 patients with multivessel disease. An angiographic success was achieved in 1198 of 1358 lesions (88%). One lesion was attempted in 338 patients (45%); 2 in 273 (37%); 3, in 101 (13%); and, 4 or more in 40 cases (5.3%). Significant complications occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction; 26 (3.5%) required urgent myocardial revascularization; and 14 (1.9%) died. An apparent lesion recurrence occurred in 233 of 658 (35%) patients with 162 of 171 (95%) having a successful second coronary angioplasty. A second apparent lesion recurrence occurred in 37 of 162 patients (23%) with 24 of 28 (86%) having a successful third coronary angioplasty. Clinical improvement (mean follow-up: 31 +/- 17 months) persisted in 81% of successful patients. The cumulative probability of survival was 91.5% at 72 months. Survival was adversely affected, at 63 months, by the presence of prior bypass surgery (no prior bypass surgery, 94% vs. prior bypass surgery, 86%; p less than 0.05): at 24 months by a low left ventricular ejection fraction (less than or equal to 35%, 82% vs. left ventricular ejection fraction greater than 35%, 95%; p less than 0.01) and, at 57 months, in the multiple dilatation group with prior bypass surgery (no bypass surgery 96% vs. prior bypass surgery 84%; p less than 0.05). Multiple dilatation had a beneficial effect upon survival, at 27 months, in patients with a left ventricular ejection fraction less than or equal to 35% [single dilatation, 74% vs. multiple dilatation, 93%; p less than 0.001], and in patients greater than or equal to 70 years, at 39 months (79% vs. multiple dilatation, 92%; p less than 0.01). These data suggest that coronary angioplasty can be an effective treatment in patients with multivessel coronary disease without the need to dilate all diseased vessels, with good success, acceptable complication rates, and a reasonable expectation of satisfactory long-term clinical improvement.
752例多支血管病变患者中，658例成功接受了经腔冠状动脉血管成形术。1358处病变中有1198处（88%）血管造影成功。338例患者（45%）尝试扩张1处病变；273例（37%）尝试扩张2处；101例（13%）尝试扩张3处；40例（5.3%）尝试扩张4处或更多处。39例患者（5.2%）发生严重并发症：19例（2.5%）发生透壁性心肌梗死；26例（3.5%）需要紧急心肌血运重建；14例（1.9%）死亡。658例患者中有233例（35%）出现明显的病变复发，其中171例中的162例（95%）成功接受了第二次冠状动脉血管成形术。162例患者中有37例（23%）出现第二次明显的病变复发，其中28例中的24例（86%）成功接受了第三次冠状动脉血管成形术。成功患者中有81%临床症状持续改善（平均随访：31±17个月）。72个月时累积生存率为91.5%。63个月时，既往接受过搭桥手术对生存率有不利影响（未接受过搭桥手术，94% vs. 接受过搭桥手术，86%；p<0.05）；24个月时，左心室射血分数低（≤35%，82% vs. 左心室射血分数>35%，95%；p<0.01）对生存率有不利影响；57个月时，既往接受过搭桥手术的多次扩张组患者生存率较低（未接受搭桥手术96% vs. 接受过搭桥手术84%；p<0.05）。对于左心室射血分数≤35%的患者，27个月时多次扩张对生存率有有益影响[单次扩张，74% vs. 多次扩张，93%；p<0.001]；对于年龄≥70岁的患者，39个月时多次扩张也有有益影响（79% vs. 多次扩张，92%；p<0.01）。这些数据表明，冠状动脉血管成形术可以作为多支冠状动脉疾病患者的有效治疗方法，无需扩张所有病变血管，成功率高，并发症发生率可接受，且对长期临床症状改善有合理的预期。
