Akins C W, Block P C
Am J Cardiol. 1984 Jun 15;53(12):108C-111C. doi: 10.1016/0002-9149(84)90760-4.
From July 1978 through April 1983, 125 patients underwent attempted PTCA at the Massachusetts General Hospital. The first 25 patients were considered to be surgical candidates after failure of the PTCA attempt regardless of the presence of acute myocardial ischemia (Group I). The subsequent 100 patients (Group II) were considered to be surgical candidates only if acute myocardial ischemia was caused by a failed PTCA attempt. Four of the Group I patients (16%) required urgent operative intervention and 7 of the Group II patients (7%) required urgent operative intervention yielding, a total of 11 patients (8.8%) of the entire group. There were no hospital deaths and only 1 MI, actually documented before cardiopulmonary bypass. Women required urgent operative intervention more frequently than men (14.7% vs 6.6%). Patients with right coronary artery lesions required urgent operative intervention more often than those with left anterior descending lesions (13.0% vs 8.0%). Factors that lead to low operative mortality and myocardial infarction rates include an available operating room and team during the PTCA attempt, systemic arterial and Swan-Ganz pulmonary artery catheter pressure measurements at the time of angioplasty, intraaortic balloon pumping at the first sign of myocardial injury and expeditious surgery.
从1978年7月至1983年4月，125例患者在马萨诸塞州总医院接受了经皮腔内冠状动脉成形术（PTCA）尝试。最初的25例患者在PTCA尝试失败后被视为手术候选者，无论是否存在急性心肌缺血（第一组）。随后的100例患者（第二组）只有在PTCA尝试失败导致急性心肌缺血时才被视为手术候选者。第一组中有4例患者（16%）需要紧急手术干预，第二组中有7例患者（7%）需要紧急手术干预，整个组共有11例患者（8.8%）。没有医院死亡病例，只有1例心肌梗死，实际上是在体外循环前记录的。女性比男性更频繁地需要紧急手术干预（14.7%对6.6%）。右冠状动脉病变患者比左前降支病变患者更常需要紧急手术干预（13.0%对8.0%）。导致低手术死亡率和心肌梗死率的因素包括在PTCA尝试期间有可用的手术室和团队、血管成形术时的全身动脉和 Swan-Ganz 肺动脉导管压力测量、心肌损伤的第一个迹象时的主动脉内球囊泵入以及迅速的手术。
