Tan K H, Sulke N, Taub N, Sowton E
Department of Cardiology, Guy's Hospital, London, U.K.
Eur Heart J. 1995 May;16(5):631-9. doi: 10.1093/oxfordjournals.eurheartj.a060966.
The acute and long-term outcome of 198 patients who underwent coronary angioplasty of ostial stenoses was evaluated. Procedural success was achieved in 85% of aorta ostial stenoses, 90% of non-aorta ostial stenoses, and 87% of branch ostial stenoses (P = 0.84). A major complication occurred in 5.9%, 6.3%, and 6.9% of patients who underwent aorta ostial, non-aorta ostial, and branch ostial stenosis angioplasty, respectively (P = 0.97). A greater residual stenosis (P = 0.005) resulted from angioplasty of aorta ostial lesions despite a greater inflation frequency (P < 0.001), inflation pressure (P < 0.001), and total inflation duration (P < 0.001). The restenosis rate was higher for aorta ostial lesions (71%) when compared to non-aorta ostial (60%) and branch ostial lesions (32%) (P = 0.01). However, since the denominator included only the 49% who returned for repeat coronary angiography, the exact angiographic restenosis rate cannot be determined. The cumulative probability of survival was 99% at 1 year and 93% at 3 years. The 1 and 3 year freedom from death, myocardial infarction, bypass surgery, and repeat angioplasty was 70% and 57%, respectively. At census, 57% were asymptomatic, and only 9% suffered severe angina. Coronary angioplasty of ostial stenoses can be carried out with an acceptable success and complication rate, and provides good symptomatic relief and favourable long-term outcome. Randomized trials to compare new angioplasty technology with balloon angioplasty will be necessary to select the best device therapy for ostial lesions.
对198例行冠状动脉开口狭窄血管成形术患者的急性和长期预后进行了评估。主动脉开口狭窄血管成形术的手术成功率为85%，非主动脉开口狭窄为90%，分支开口狭窄为87%（P = 0.84）。分别接受主动脉开口、非主动脉开口和分支开口狭窄血管成形术的患者中，主要并发症发生率分别为5.9%、6.3%和6.9%（P = 0.97）。尽管主动脉开口病变血管成形术的球囊充盈频率更高（P < 0.001）、充盈压力更高（P < 0.001）以及总充盈持续时间更长（P < 0.001），但仍导致了更大的残余狭窄（P = 0.005）。与非主动脉开口病变（60%）和分支开口病变（32%）相比，主动脉开口病变的再狭窄率更高（71%）（P = 0.01）。然而，由于分母仅包括返回接受重复冠状动脉造影的49%的患者，因此无法确定确切的血管造影再狭窄率。1年时的累积生存概率为99%，3年时为93%。1年和3年无死亡、心肌梗死、搭桥手术和重复血管成形术的自由度分别为70%和57%。在普查时，57%的患者无症状，只有9%的患者患有严重心绞痛。冠状动脉开口狭窄血管成形术可以在可接受的成功率和并发症发生率下进行，并能提供良好的症状缓解和有利的长期预后。有必要进行随机试验，比较新的血管成形术技术与球囊血管成形术，以选择针对开口病变的最佳器械治疗方法。
