Sotirov I, Lessana A, Romano M, Royer T, Glatt B, Morice M C
Centre cardiologique du Nord, Saint-Denis.
Arch Mal Coeur Vaiss. 1993 Sep;86(9):1311-6.
This retrospective study of 4,000 coronary angioplasty procedures performed between 1/1/87 and 31/1/92 was undertaken to assess the benefits of new therapeutic options (perfusion balloon catheter, temporary and permanent stenting, laser balloon angioplasty, cardiopulmonary bypass) in the management of major complications of angioplasty and to evaluate the results of emergency coronary bypass surgery. Angioplasty was performed before (1,000 angioplasties: Group 1) and after (3,000 angioplasties: Group 2) the introduction of these new techniques at the Centre cardiologique du Nord. Despite the increasing complexity of the clinical and angiographic features of the patients, the global results show a significant decrease in the rates of emergency bypass surgery (2.1% in Group 1 versus 0.7% in Group 2; p < 0.0015) and of periprocedural acute myocardial infarctions (1.8% in Group 1 versus 0.7% in Group 2; p < 0.015). The use of these new techniques in cases of acute complications of coronary angioplasty decreases the signs of ischaemia before surgery (61.9% in Group 1 versus 68.1% in Group 2; p < 0.05). Coronary bypass surgery was performed under haemodynamically stable conditions in all patients requiring the procedure in Group 2, enabling the surgeon to perform more complete revascularisation with implantation of the mammary artery in 50% of cases (9.5% of cases in Group 1; p < 0.001). The interval to emergency bypass surgery depends mainly on the rapidity of the operative decision in cases of failure of these new techniques.
本回顾性研究对1987年1月1日至1992年1月31日期间进行的4000例冠状动脉血管成形术进行了分析，旨在评估新治疗方法（灌注球囊导管、临时和永久性支架植入、激光球囊血管成形术、体外循环）在处理血管成形术主要并发症方面的益处，并评估急诊冠状动脉搭桥手术的效果。在法国北部心脏病中心，血管成形术在引入这些新技术之前（1000例血管成形术：第1组）和之后（3000例血管成形术：第2组）进行。尽管患者的临床和血管造影特征日益复杂，但总体结果显示急诊搭桥手术率显著降低（第1组为2.1%，第2组为0.7%；p<0.0015），围手术期急性心肌梗死发生率也显著降低（第1组为1.8%，第2组为0.7%；p<0.015）。在冠状动脉血管成形术急性并发症病例中使用这些新技术可减少术前缺血症状（第1组为61.9%，第2组为68.1%；p<0.05）。在第2组中，所有需要进行该手术的患者均在血流动力学稳定的情况下进行冠状动脉搭桥手术，这使得外科医生能够在50%的病例中更完全地进行血管重建，即植入乳内动脉（第1组为9.5%的病例；p<0.001）。急诊搭桥手术的间隔时间主要取决于这些新技术失败时手术决策的速度。
