Shawl F A, Quyyumi A A, Bajaj S, Hoff S B, Dougherty K G
Department of Interventional Cardiology, Washington Adventist Hospital, Takoma Park, Maryland 20912, USA.
Am J Cardiol. 1996 Jan 1;77(1):14-9. doi: 10.1016/s0002-9149(97)89127-8.
The objective of this study was to determine the acute and long-term results of percutaneous cardiopulmonary bypass-supported angioplasty in treating high-risk patients with unstable presentations and severely depressed left ventricular (LV) function (ejection fraction [EF] < or = 25%). One hundred seven consecutive patients with a mean LVEF of 19 +/- 3% were studied. Seventy-four patients (69%) had unstable angina, 60 (56%) had New York Heart Association class III or IV symptoms, 74 (69%) had recent (< 15 days) documented acute myocardial infarction, 103 (96%) had 3-vessel disease, and 58 (54%) had only 1 remaining patent artery. A total of 50 patients (47%) were deemed unsuitable for bypass surgery. Of 196 severe narrowings attempted in 166 coronary arteries, 193 (98%) were successfully dilated in 105 patients (98%), and there was no procedure-related mortality, Q-wave myocardial infarction, or urgent requirement for coronary bypass surgery. There were 5 in-hospital deaths (4.7%) and the remaining 102 patients have been followed for 24.5 +/- 1.3 (mean +/- SE) months. Twenty-three patients (21%) died between 1 and 23 months after the procedure. One- and 2-year survival free of cardiac death was 83% and 77%, respectively. Of the 79 surviving patients, 65 have survived event free of myocardial infarction and revascularization; event-free survival for 1 and 2 years was 76% and 69.5%, respectively. In the 64 patients in whom LV function was measured before and after the procedure, global EF increased from 20.6% to 29.3% (p < 0.001). Patients who remained event free had a greater improvement in LVEF than those who had a cardiac event during follow-up (p < 0.05). Thus, this study demonstrates the safety and efficacy of percutaneous cardiopulmonary bypass-supported angioplasty in the immediate treatment of high-risk unstable patients with multivessel coronary artery disease and severely depressed LV function.
本研究的目的是确定经皮心肺转流支持下的血管成形术治疗具有不稳定表现且左心室（LV）功能严重受损（射血分数[EF]≤25%）的高危患者的急性和长期结果。对107例连续患者进行了研究，其平均左心室射血分数为19±3%。74例患者（69%）患有不稳定型心绞痛，60例（56%）有纽约心脏协会III或IV级症状，74例（69%）近期（<15天）有记录的急性心肌梗死，103例（96%）有三支血管病变，58例（54%）仅余1支通畅血管。共有50例患者（47%）被认为不适合进行搭桥手术。在166支冠状动脉中尝试进行的196处严重狭窄病变，193处（98%）在105例患者（98%）中成功扩张，且无手术相关死亡、Q波心肌梗死或紧急冠状动脉搭桥手术需求。有5例住院死亡（4.7%），其余102例患者已随访24.5±1.3（平均±标准误）个月。23例患者（21%）在术后1至23个月之间死亡。无心脏死亡的1年和2年生存率分别为83%和77%。在79例存活患者中，65例存活且无心肌梗死和血运重建事件；1年和2年无事件生存率分别为76%和69.5%。在64例术前和术后测量左心室功能的患者中，整体射血分数从20.6%提高到29.3%（p<0.001）。无事件存活的患者左心室射血分数的改善大于随访期间发生心脏事件的患者（p<0.05）。因此，本研究证明了经皮心肺转流支持下的血管成形术在即刻治疗多支冠状动脉疾病且左心室功能严重受损的高危不稳定患者中的安全性和有效性。
