Weintraub W S, King S B, Douglas J S, Kosinski A S
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
J Am Coll Cardiol. 1995 Jul;26(1):142-51. doi: 10.1016/0735-1097(95)00136-n.
We sought to compare in-hospital and long-term outcome after angioplasty in patients with single-, double- and triple-vessel disease.
Coronary angioplasty is increasingly used in patients with multivessel disease.
The source of data was the clinical data base at Emory University. Patients who had previous coronary revascularization or who underwent angioplasty in the setting of acute myocardial infarction were excluded.
Of 10,783 patients, 71% had one-vessel, 24% two-vessel and 5% three-vessel disease. Age, male gender, diabetes, hypertension, history of previous myocardial infarction, Canadian Cardiovascular Society class III or IV angina and congestive failure all increased with severity of disease. Complete revascularization was achieved in most patients with one-vessel disease, in a minority with two-vessel disease and rarely in those with three-vessel disease. Emergency coronary bypass surgery increased from 1.7% with one-vessel disease to 3.2% with three-vessel disease. Q wave myocardial infarctions could not be shown to vary significantly with severity of disease. The mortality rate increased from 0.2% with one-vessel disease to 1.2% with three-vessel disease. The number of vessels diseased was a multivariate correlate of in-hospital and long-term mortality. The 1-, 5- and 10-year survival was 0.99, 0.93 and 0.86 for one-vessel disease and 0.97, 0.89 and 0.76 for two-vessel disease, respectively. The 1-, 5- and 9-year survival was 0.95, 0.85 and 0.70 in three-vessel disease, respectively. Freedom from myocardial infarction, coronary bypass surgery and repeat angioplasty was also lower with more severe disease.
Patients have increasing in-hospital and long-term mortality as the severity of disease increases. There is also an increased incidence of myocardial infarction and revascularization procedures with more severe disease.
我们试图比较单支、双支和三支血管病变患者血管成形术后的院内及长期预后。
冠状动脉血管成形术在多支血管病变患者中的应用日益增加。
数据来源为埃默里大学的临床数据库。排除既往有冠状动脉血运重建或在急性心肌梗死情况下接受血管成形术的患者。
在10783例患者中，71%为单支血管病变，24%为双支血管病变，5%为三支血管病变。年龄、男性、糖尿病、高血压、既往心肌梗死病史、加拿大心血管学会III或IV级心绞痛以及充血性心力衰竭均随疾病严重程度增加而增多。大多数单支血管病变患者实现了完全血运重建，少数双支血管病变患者实现了完全血运重建，而三支血管病变患者很少实现完全血运重建。急诊冠状动脉搭桥手术从单支血管病变患者的1.7%增至三支血管病变患者的3.2%。Q波心肌梗死未显示随疾病严重程度有显著差异。死亡率从单支血管病变患者的0.2%增至三支血管病变患者的1.2%。病变血管数量是院内及长期死亡率的多变量相关因素。单支血管病变患者的1年、5年和10年生存率分别为0.99、0.93和0.86，双支血管病变患者分别为0.97、0.89和0.76。三支血管病变患者的1年、5年和9年生存率分别为0.95、0.85和0.70。疾病越严重，无心肌梗死、冠状动脉搭桥手术及再次血管成形术的生存率也越低。
随着疾病严重程度增加，患者的院内及长期死亡率升高。疾病越严重，心肌梗死及血运重建手术的发生率也越高。
