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[冠状动脉成形术后6个月血管造影再狭窄的发生率及长期预后]

[Frequency of angiographic restenosis after 6 months and long-term outcome of coronary angioplasty].

作者信息

Lagrange P, Virot P, Doumeix J J, Cassat C, Maudière A, Abrieu O, Leymarie J L, Bensaid J

机构信息

Service de cardiologie, CHU Dupuytren, Limoges.

出版信息

Arch Mal Coeur Vaiss. 1994 Sep;87(9):1161-7.

PMID:7646229
Abstract

Five hundred patients with a mean age of 59 years were followed up for an average of 32 months after coronary angioplasty. All patients were included in a prospective study comprising coronary angiography at 6 months for 379 patients (91% primary successes). The long-term outcome was evaluated by a questionnaire or telephone interview in all cases. The global primary success rate was 84.4% in this series. The primary failures include 1.8 fatalities, 0.6% myocardial infarction, 2% emergency coronary bypass surgery and 11.2% without immediate clinical consequences. At 6 months, there were 48% of restenoses (182/379 patients) and 28% underwent immediate repeat angioplasty (141/500 patients) with a primary success rate of 91%. After the repeat angioplasty, the restenosis rate was 43% but this varied according to the time from the first restenosis: 60% when the interval was short (under 2 months) compared with 21% when the interval was 6 months (p < 0.01). The actuarial survival rates at 4 years were 95% after successful angioplasty 96% after uncomplicated failures or medically treated restenosis and 98% after bypass surgery. The predictive factors for secondary death were age of over 70 years, previous non-thrombolized myocardial infarction and complications of angioplasty. The long-term outcome was good despite the 48% 6 months restenosis rate requiring revascularisation procedure in 73% of cases.

摘要

500例平均年龄为59岁的患者在冠状动脉血管成形术后平均随访32个月。所有患者均纳入一项前瞻性研究,其中379例患者(91%为初次成功)在6个月时接受冠状动脉造影。所有病例均通过问卷调查或电话访谈评估长期预后。本系列研究中总体初次成功率为84.4%。初次失败包括1.8例死亡、0.6%的心肌梗死、2%的急诊冠状动脉搭桥手术以及11.2%无即刻临床后果的情况。在6个月时,有48%的患者发生再狭窄(182/379例患者),28%的患者接受了即刻重复血管成形术(141/500例患者),初次成功率为91%。重复血管成形术后,再狭窄率为43%,但根据距首次再狭窄的时间不同而有所变化:间隔时间短(2个月以内)时为60%,而间隔6个月时为21%(p<0.01)。成功血管成形术后4年的精算生存率为95%,无并发症失败或药物治疗再狭窄后为96%,冠状动脉搭桥手术后为98%。二次死亡的预测因素为年龄超过70岁、既往未溶栓的心肌梗死以及血管成形术并发症。尽管6个月时再狭窄率为48%,73%的病例需要进行血运重建手术,但长期预后良好。

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