Valentini P, De Servi S, Barberis P, Angoli L, Bramucci E, Costante A M, Mariani G, Specchia G
Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia.
G Ital Cardiol. 1995 Feb;25(2):159-65.
Over the last years there has been a tremendous increase in coronary angioplasty procedures (PTCA), due to the availability of better materials and to the refinement of operators skill. It is not known however if this "PTCA boom" has modified our approach to the patients with particular clinical situations, such as those with non-Q wave myocardial infarction. The purpose of this study was to verify, in patients undergoing coronary angiography for clinical reasons after a non-Q wave myocardial infarction, the clinical decision concerning the therapeutical choice in two different periods (101 patients in 1988 vs. 102 patients in 1992).
Patients in the two groups had similar clinical manifestations whereas patients observed in 1992 had more frequently 2-vessel disease than single vessel disease as compared to patients studied in 1988 (p < 0.05). The distribution of patients with normal coronary arteries or with 3-vessel disease was similar in the two periods. In 1988 medical therapy was the most recommended treatment at discharge (47%), followed by aorto-coronary bypass (29%) and coronary angioplasty (24%). On the contrary, in 1992 PTCA was performed in 48% of patients, medical therapy was recommended in 28% while the incidence of coronary surgery was reduced to 24% (p < 0.01). From a clinical point of view a significant increase in PTCA procedures was seen in patients presenting with unstable angina after the non-Q wave myocardial infarction (54% of these patients undergoing PTCA in 1992 vs. 30% in 1988, p = 0.03) and in patients with effort angina and a positive exercise test at low workload (53% of these patients undergoing PTCA in 1992 vs. 22% in 1988, p < 0.05). Moreover, in 1992 PTCA procedures increased in patients with single vessel disease (64% in 1992 vs. 49% in 1988) and in patients with 2-vessel disease (64% in 1992 vs. 9% in 1988). Therefore, in these patients the need of aorto-coronary by pass was reduced from 39% in 1988 to 19% in 1992 (p < 0.05). The success rate of PTCA procedures was 98% in 1992 and 83% in 1988. No major complications were observed in the two study periods and no patients underwent urgent coronary surgery.
These data show an increase in PTCA procedures over the last years in patients undergoing coronary angiography for clinical reasons after a non-Q wave myocardial infarction. The greater experience of operators allowed for improved results, thus reducing the need of coronary surgery in these patients.
在过去几年中，由于更好材料的出现以及操作者技能的提升，冠状动脉血管成形术（PTCA）的手术量大幅增加。然而，目前尚不清楚这种“PTCA热潮”是否改变了我们对特定临床情况患者的治疗方法，比如非Q波心肌梗死患者。本研究的目的是在因临床原因接受冠状动脉造影的非Q波心肌梗死患者中，验证两个不同时期（1988年的101例患者与1992年的102例患者）关于治疗选择的临床决策。
两组患者的临床表现相似，然而与1988年研究的患者相比，1992年观察到的患者双支血管病变比单支血管病变更为常见（p<0.05）。两个时期冠状动脉正常或三支血管病变患者的分布相似。1988年，出院时最推荐的治疗方法是药物治疗（47%），其次是主动脉冠状动脉搭桥术（29%）和冠状动脉血管成形术（24%）。相反，1992年48%的患者接受了PTCA，28%的患者推荐药物治疗，而冠状动脉手术的发生率降至24%（p<0.01）。从临床角度来看，非Q波心肌梗死后出现不稳定型心绞痛的患者中PTCA手术显著增加（1992年这些患者中有54%接受PTCA，1988年为30%，p=0.03），以及运动性心绞痛且低负荷运动试验阳性的患者中PTCA手术也显著增加（1992年这些患者中有53%接受PTCA，1988年为22%，p<0.05）。此外，1992年单支血管病变患者（1992年为64%，1988年为49%）和双支血管病变患者（1992年为64%，1988年为9%）的PTCA手术也有所增加。因此，这些患者中主动脉冠状动脉搭桥术的需求从1988年的39%降至1992年的19%（p<0.05）。1992年PTCA手术的成功率为98%，1988年为83%。在两个研究时期均未观察到重大并发症，也没有患者接受紧急冠状动脉手术。
这些数据表明，在过去几年中，因临床原因接受冠状动脉造影的非Q波心肌梗死患者的PTCA手术有所增加。操作者经验的增加带来了更好的结果，从而减少了这些患者对冠状动脉手术的需求。
