Preisack M B, Athanasiadis A, Voelker W, Karsch K R
Department of Cardiology, Tübingen University, Germany.
J Am Coll Cardiol. 1993 Mar 15;21(4):876-84. doi: 10.1016/0735-1097(93)90342-x.
This prospective trial was performed to evaluate the impact of the morphologic complications of angioplasty on the reliability and results of quantitative angiographic assessment of the residual stenosis.
Postintervention quantitative coronary analysis is limited by a variety of such complications.
In 199 patients undergoing an early control angiographic study within 24 h after coronary balloon or excimer laser angioplasty (24-h study), detailed quantitative angiographic measurements were performed on the target lesion immediately after intervention and at the 24-h study. Reproducibility of quantitative arteriography was determined by repeat measurements on the same angiogram.
Intraobserver/interobserver variability was significantly higher (p < 0.0001/p < 0.03) for the postintervention angiogram than for the 24-h angiogram. Patients were classified into three subgroups with respect to the occurrence of angiographic complications or chest pain after intervention. In patients with angiographic complications after balloon angioplasty alone/stand-alone laser angioplasty/laser angioplasty with adjunctive balloon dilation, a significant difference in mean minimal lumen diameter (p = 0.0001/p = 0.03/p = 0.035) was observed between the immediate postintervention and 24-h angiogram. In patients without angiographic complications or patients with recurrent chest pain undergoing balloon angioplasty, stand-alone or adjunctive laser angioplasty, mean minimal lumen diameter remained nearly unchanged (p = NS).
Angiographic measurements of the target lesion immediately after angioplasty were significantly less reliable than measurements obtained at 24 h after angioplasty in patients with angiographic complications. The occurrence of postintervention vascular complications was associated with significant early lesion changes between the immediate postangioplasty and the 24-h angiogram.
进行这项前瞻性试验以评估血管成形术的形态学并发症对残余狭窄定量血管造影评估的可靠性及结果的影响。
干预后定量冠状动脉分析受到多种此类并发症的限制。
对199例在冠状动脉球囊或准分子激光血管成形术后24小时内接受早期对照血管造影研究的患者（24小时研究），在干预后即刻及24小时研究时对靶病变进行详细的定量血管造影测量。通过对同一血管造影进行重复测量来确定定量血管造影的可重复性。
干预后血管造影的观察者内/观察者间变异性显著高于24小时血管造影（p<0.0001/p<0.03）。根据干预后血管造影并发症或胸痛的发生情况将患者分为三个亚组。在单纯球囊血管成形术/单纯激光血管成形术/联合球囊扩张的激光血管成形术后出现血管造影并发症的患者中，干预后即刻与24小时血管造影之间平均最小管腔直径存在显著差异（p = 0.0001/p = 0.03/p = 0.035）。在无血管造影并发症的患者或接受球囊血管成形术、单纯或联合激光血管成形术且有复发性胸痛的患者中，平均最小管腔直径几乎保持不变（p = 无显著性差异）。
在有血管造影并发症的患者中，血管成形术后即刻对靶病变的血管造影测量远不如血管成形术后24小时获得的测量可靠。干预后血管并发症的发生与血管成形术后即刻至24小时血管造影之间早期病变的显著变化相关。
