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[经皮腔内冠状动脉成形术后的中期随访。关于500例连续手术的临床结果、死亡率、发病率]

[Mid-term follow-up after transluminal coronary angioplasty. Clinical results, mortality, morbidity apropos of 500 consecutive procedures].

作者信息

Defaye P, Bertrand B, Machecourt J, Vanzetto G, Denis B

机构信息

Clinique Cardiologique et Urgences Cardiologiques, CHU, Grenoble.

出版信息

Ann Cardiol Angeiol (Paris). 1993 Jan;42(1):13-21.

PMID:8480979
Abstract

The aim of this study was evaluation of mid-term results, with a mean follow-up of 23 months (range: 6 months to 6 years), in 449 patients undergoing 500 consecutive angioplasty procedures before 1989. All of these 449 patients underwent primary angioplasty, and not dilatation after restenosis. Data processing of information, based upon a questionnaire filled out by the patient's own cardiologist, enabled 100 per cent follow-up. In these patients with a mean age of 56 (range: 32-83), angioplasty was single in 93 per cent of cases. The indication was unstable angina (45%), following a myocardial infarction (44%) or, more rarely, stable angina (10%). The anterior interventricular was dilated more often than the right coronary and circumflex (56%, 31% and 22% respectively). The cardiac survival rate of 41 months was 94.3 per cent, 78 per cent of patients not having experienced any serious coronary events at the time of last available information. 65 (sixty five) per cent of patients were asymptomatic and the Thallium stress test was normal in 67 per cent of them. Angina recurred in 17 per cent of patients, twice as often in women (p < 0.02). 14 (fourteen) per cent had undergone a bypass procedure and 14 per cent had been redilated. Comparisons by the Kaplan-Meier method showed less good results after the age of 57: higher mortality (p < 0.01), more frequent recurrences of angina (p < 0.05), more frequent aorto-coronary bypasses (p < 0.001). Aorto-coronary bypasses were commoner after dilatation of the anterior interventricular (p < 0.005), after multiple dilatations (p < 0.03) or after unstable angina (p < 0.05).

摘要

本研究旨在评估1989年前连续接受500例血管成形术的449例患者的中期结果,平均随访23个月(范围:6个月至6年)。这449例患者均接受了初次血管成形术,而非再狭窄后的扩张术。基于患者自己的心脏病专家填写的问卷进行信息数据处理,实现了100%的随访。这些患者的平均年龄为56岁(范围:32 - 83岁),93%的病例血管成形术为单次。手术指征为不稳定型心绞痛(45%)、心肌梗死后(44%),或较少见的稳定型心绞痛(10%)。前室间支血管比右冠状动脉和回旋支血管更常被扩张(分别为56%、31%和22%)。41个月时的心脏生存率为94.3%,78%的患者在最后一次可获得信息时未经历任何严重的冠状动脉事件。65%的患者无症状,其中67%的患者铊负荷试验正常。17%的患者心绞痛复发,女性复发频率是男性的两倍(p < 0.02)。14%的患者接受了搭桥手术,14%的患者接受了再次扩张术。采用Kaplan-Meier方法进行比较显示,57岁以后结果较差:死亡率更高(p < 0.01)、心绞痛复发更频繁(p < 0.05)、主动脉冠状动脉搭桥术更频繁(p < 0.001)。在前室间支血管扩张后(p < 0.005)、多次扩张后(p < 0.03)或不稳定型心绞痛后(p < 0.05),主动脉冠状动脉搭桥术更为常见。

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