Eltchaninoff H, Whitlow P L
Service de cardiologie, hôpital Charles-Nicolle, Rouen.
Arch Mal Coeur Vaiss. 1994 Apr;87(4):485-90.
Left ventricular function is the main predictive factor for survival in coronary patients and the results of coronary bypass surgery in left ventricular dysfunction have been widely reported. The authors undertook a retrospective study of the success rate, the risks and clinical outcome after coronary angioplasty of 182 patients with a left ventricular ejection fraction < or = 35% (30 +/- 4%). The average age was 61 +/- 10 years and 78% were men. One hundred and fifty three patients had a history of myocardial infarction. The primary success rate of angioplasty was 95% (271/284 lesions) including the multiple procedures in 24% of cases. There was a 7.1% frequency of major complications (7 deaths, 3 non-Q wave infarctions, 4 emergency coronary bypass procedures). An average follow-up period of 32 months was obtained in 98.4% of patients. Seven patients developed a myocardial infarction and 14 patients were rehospitalized for cardiac failure (N = 6) or severe ventricular arrhythmias (N = 8). A control coronary angiography was performed in 100 cases either as a routine investigation or for recurrence of symptoms. Restenosis was demonstrated in 33 cases, an aggravation of lesions on another vessel in 12 cases and restenosis associated with aggravation of other lesions in 5 cases, leading to redilatation in 26 cases, atherectomy in 2 cases and coronary bypass surgery in 16 cases. Forty-one patients died (25%). Ten patients died before the 6th month and 31 died secondarily. The only parameter which was significantly correlated with survival was the value of the ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
左心室功能是冠心病患者生存的主要预测因素,左心室功能不全患者冠状动脉搭桥手术的结果已有广泛报道。作者对182例左心室射血分数≤35%(30±4%)患者进行冠状动脉成形术后的成功率、风险及临床结局进行了回顾性研究。平均年龄为61±10岁,男性占78%。153例患者有心肌梗死病史。血管成形术的主要成功率为95%(284处病变中的271处),其中24%的病例进行了多次手术。主要并发症发生率为7.1%(7例死亡,3例非Q波梗死,4例急诊冠状动脉搭桥手术)。98.4%的患者平均随访32个月。7例患者发生心肌梗死,14例患者因心力衰竭(6例)或严重室性心律失常(8例)再次住院。100例患者进行了对照冠状动脉造影,要么作为常规检查,要么用于症状复发。33例显示再狭窄,12例其他血管病变加重,5例再狭窄合并其他病变加重,导致26例再次扩张,2例旋切术,16例冠状动脉搭桥手术。41例患者死亡(25%)。10例患者在第6个月前死亡,31例继发死亡。与生存显著相关的唯一参数是射血分数值。(摘要截断于250字)