Eltchaninoff H, Franco I, Whitlow P L
Department of Cardiology F25, Cleveland Clinic Foundation, Ohio 44195-5001.
Am J Cardiol. 1994 Jun 1;73(15):1047-52. doi: 10.1016/0002-9149(94)90281-x.
Left ventricular (LV) function is the most important independent predictor of long-term survival in patients with coronary artery disease, and results of bypass surgery improving survival in the setting of depressed LV function are well documented. Data regarding long-term outcome in patients undergoing coronary angioplasty are limited. From 1983 through 1989, 343 consecutive patients with an ejection fraction (EF) < or = 40% (mean 34% +/- 5%) undergoing elective coronary angioplasty were evaluated, retrospectively. The mean age was 61 +/- 10 years and 80% were men. Angiographic success (469 of 496 narrowings) was 95%. Major complications occurred in 26 patients (7.6%): emergency bypass surgery (n = 11), nonfatal myocardial infarction (n = 8), and death (n = 9). Follow-up was available for 99% of patients with clinical success (mean = 36 +/- 22 months). Fourteen patients (4.5%) developed nonfatal myocardial infarction and 72 patients (23%) had symptomatic restenosis, 32 patients requiring repeat angioplasty or atherectomy and 29 bypass surgery. Fifty-six patients (18.2%) died. Three-year survival was 84%. EF was a significant predictor of death: 3-year survival was 69%, 83% and 92%, respectively, in patients with EF < or = 30%, 31% to 35%, and 36% to 40% (p = 0.0001). A high angiographic success rate and an acceptable procedural risk were encountered in patients with depressed LV function undergoing angioplasty. The 3-year mortality rate, however, is substantial and directly related to the degree of LV dysfunction.
左心室（LV）功能是冠心病患者长期生存最重要的独立预测因素，并且在左心室功能降低的情况下，搭桥手术改善生存的结果已有充分记录。关于接受冠状动脉成形术患者的长期预后的数据有限。从1983年至1989年，对343例连续接受择期冠状动脉成形术且射血分数（EF）≤40%（平均34%±5%）的患者进行了回顾性评估。平均年龄为61±10岁，80%为男性。血管造影成功率（496处狭窄中的469处）为95%。26例患者（7.6%）发生了主要并发症：急诊搭桥手术（n = 11）、非致命性心肌梗死（n = 8）和死亡（n = 9）。99%临床成功的患者获得了随访（平均 = 36±22个月）。14例患者（4.5%）发生了非致命性心肌梗死，72例患者（23%）出现了有症状的再狭窄，32例患者需要再次进行血管成形术或旋切术，29例患者需要进行搭桥手术。56例患者（18.2%）死亡。三年生存率为84%。EF是死亡的重要预测因素：EF≤30%、31%至35%以及36%至40%的患者三年生存率分别为69%、83%和92%（p = 0.0001）。接受血管成形术的左心室功能降低患者具有较高的血管造影成功率和可接受的手术风险。然而，三年死亡率很高，且与左心室功能障碍的程度直接相关。
