Tan K H, Sulke N, Taub N, Karani S, Sowton E
Department of Cardiology, Guy's Hospital, London.
Br Heart J. 1995 Apr;73(4):327-33. doi: 10.1136/hrt.73.4.327.
To report on the short-term and long-term results of patients who underwent a third coronary balloon angioplasty for a second restenosis and to identify the correlates of a third clinical restenosis.
A retrospective analysis of clinical, angiographic, and procedure related variables of a consecutive series of patients.
62 patients (mean (range) age 53 (31-72) years; 84% men) who underwent a third coronary balloon angioplasty of a single coronary artery segment at which restenosis had occurred after two previous angioplasty procedures between 1986 and 1992.
Procedure success was achieved in 56 patients (90%). Complications included one myocardial infarction (2%) and one emergency coronary artery bypass surgery (2%). Complete follow up data were available (median (range) 48 (12-94) months). During the follow up period, four patients (6%) died, two (3%) had a non-fatal myocardial infarction, and five (8%) underwent elective coronary artery bypass surgery. Nine patients (14%) underwent a fourth angioplasty for a third clinical restenosis, and three (5%) had a fourth angioplasty procedure for new coronary lesions. The cumulative probability of survival for all 62 patients was 97% and 95% at 1 and 5 years, respectively. The 1 and 5 year freedom from death, infarction, bypass surgery, and repeat angioplasty was 82% and 66.6%, respectively. At census, of the 58 survivors, 31 (53%) were asymptomatic and only eight (14%) complained of angina grade III or IV (P < 0.001). A third clinical restenosis occurred in 22 (39%) of the 56 patients who had initially successful procedures. Multiple stepwise logistic regression analysis identified the interval between the second and third angioplasty procedure as the only independent predictor of a third clinical restenosis (P = 0.004).
A third coronary angioplasty for a second restenosis can be performed safely and effectively and should be considered as an integral part of the overall coronary angioplasty revascularisation strategy. The incidence of a third clinical restenosis remains high, however, and is correlated with the interval between the previous angioplasty procedures.
报告因第二次再狭窄接受第三次冠状动脉球囊血管成形术患者的短期和长期结果，并确定第三次临床再狭窄的相关因素。
对一系列连续患者的临床、血管造影和手术相关变量进行回顾性分析。
62例患者（平均（范围）年龄53（31 - 72）岁；84%为男性），于1986年至1992年间，在先前两次血管成形术后，对发生再狭窄的单一冠状动脉节段进行第三次冠状动脉球囊血管成形术。
56例患者（90%）手术成功。并发症包括1例心肌梗死（2%）和1例急诊冠状动脉搭桥手术（2%）。可获得完整的随访数据（中位（范围）48（12 - 94）个月）。在随访期间，4例患者（6%）死亡，2例（3%）发生非致命性心肌梗死，5例（8%）接受择期冠状动脉搭桥手术。9例患者（14%）因第三次临床再狭窄接受第四次血管成形术，3例（5%）因新发冠状动脉病变接受第四次血管成形术。所有62例患者1年和5年的累积生存率分别为97%和95%。1年和5年无死亡、梗死、搭桥手术及再次血管成形术的生存率分别为82%和66.6%。在随访时，58例存活者中，31例（53%）无症状，只有8例（14%）主诉Ⅲ或Ⅳ级心绞痛（P < 0.001）。56例初始手术成功的患者中有22例（39%）发生第三次临床再狭窄。多因素逐步逻辑回归分析确定第二次和第三次血管成形术之间的间隔是第三次临床再狭窄的唯一独立预测因素（P = 0.004）。
因第二次再狭窄进行第三次冠状动脉血管成形术可安全有效地进行，应被视为冠状动脉血管成形术整体血运重建策略的一个组成部分。然而，第三次临床再狭窄的发生率仍然很高，且与先前血管成形术之间的间隔有关。
