Beurrier D, Tricoche O, Feldmann L, Juillière Y, Buffet P, Anconina J, Cherrier F, Danchin N
Service de cardiologie A, CHU Nancy-Brabois, Vandoeuvre-lès-Nancy.
Arch Mal Coeur Vaiss. 1995 Feb;88(2):225-30.
Transluminal coronary angioplasty is increasingly performed in patients with left ventricular dysfunction. However, there is little data available concerning the outcome of these patients. The aim of this retrospective study was to assess the immediate and long-term results in 90 patients (76 men and 14 women) with left ventricular ejection fractions < or = 35% (average 29 +/- 5%) undergoing angioplasty between 1980 and December 1992. Eighty-seven patients (96%) had a history of infarction, 27 (30%) had already at least one episode of left ventricular failure and 34 (38%) had unstable angina at the time of angioplasty. The coronary disease was usually multi-vessel. A total of 118 lesions were dilated with a primary success rate of 77% (91/118): 86% (82/95) in non-occlusive stenoses and 39% (9/23) in complete obstructions. The total success rate per procedure was 72% (65/90) with a hospital mortality rate of 5.5% (5 cases). The mean follow-up period was 53 +/- 47 months. Twelve patients died during this period and two were lost to follow-up. The total and cardiovascular mortality at the end of the study was 19% (17/88). Eight of the 71 survivors underwent another revascularisation procedure (4 bypasses and 4 angioplasties); 21 (29%) have stable angina, 50 (71%) have no anginal pain and 61 (86%) have antianginal treatment. The probability of survival at one and four years was 81 +/- 4% and 79 +/- 5%, respectively. A multivariate analysis using the Cox model showed three independent prognostic factors for long-term mortality: triple coronary vessel disease, the best predictive factor, left ventricular ejection fraction and female gender.(ABSTRACT TRUNCATED AT 250 WORDS)
经腔冠状动脉血管成形术越来越多地应用于左心室功能不全的患者。然而，关于这些患者的治疗结果，可用数据很少。这项回顾性研究的目的是评估1980年至1992年12月期间90例（76例男性和14例女性）左心室射血分数≤35%（平均29±5%）接受血管成形术患者的近期和长期结果。87例（96%）有梗死病史，27例（30%）至少有一次左心室衰竭发作，34例（38%）在血管成形术时患有不稳定型心绞痛。冠状动脉疾病通常为多支血管病变。共扩张了118处病变，初始成功率为77%（91/118）：非闭塞性狭窄为86%（82/95），完全闭塞为39%（9/23）。每次手术的总成功率为72%（65/90），医院死亡率为5.5%（5例）。平均随访期为53±47个月。在此期间，12例患者死亡，2例失访。研究结束时的总死亡率和心血管死亡率为19%（17/88）。71例幸存者中有8例接受了另一次血运重建手术（4例搭桥手术和4例血管成形术）；21例（29%）有稳定型心绞痛，50例（71%）无心绞痛，61例（86%）接受抗心绞痛治疗。1年和4年的生存率分别为81±4%和79±5%。使用Cox模型进行的多变量分析显示，长期死亡率的三个独立预后因素为：三支冠状动脉血管病变，最佳预测因素，左心室射血分数和女性性别。（摘要截短于250字）
