Ruygrok P N, de Jaegere P T, van Domburg R T, van den Brand M J, Serruys P W, de Feyter P J
Catheterization Laboratory, Erasmus University, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1996 Jun;27(7):1669-77. doi: 10.1016/0735-1097(96)00046-0.
This study reports the 10-year outcome of 856 consecutive patients who underwent attempted coronary angioplasty at the Thoraxcenter during the years 1980 to 1985.
Coronary balloon angioplasty was first performed in 1977, and this procedure was introduced into clinical practice at the Thoraxcenter in 1980. Although advances have been made, extending our knowledge of the long-term outcome in terms of survival and major cardiac events remains of interest and a valuable guide in the treatment of patients with coronary artery disease.
Details of survival, cardiac events, symptoms and medication were retrospectively obtained from the Dutch civil registry, medical records or by letter or telephone or from the patient's physician and entered into a dedicated data base. Patient survival curves were constructed, and factors influencing survival and cardiac events were identified.
The procedural clinical success rate was 82%. Follow-up information was obtained in 837 patients (97.8%). Six hundred forty-one patients (77%) were alive, of whom 334 (53%) were symptom free, and 254 (40%) were taking no antianginal medication. The overall 5- and 10-year survival rates were 90% (95% confidence interval [CI] 87.6% to 92.4%) and 78% (95% CI 75.0% to 81.0%), respectively, and the respective freedom from significant cardiac events (death, myocardial infarction, coronary artery bypass surgery and repeat angioplasty) was 57% (95% CI 53.4% to 60.6%) and 36% (95% CI 32.4% to 39.6%). Factors that were found to adversely influence 10-year survival were age > or = 60 years (> or = 60 years [67%], 50 to 59 years [82%], < 50 years [88%]), multivessel disease (multivessel disease [69%], single-vessel disease [82%]), impaired left ventricular function (ejection fraction < 50% [57%], > or = 50% [80%]) and a history of previous myocardial infarction (previous myocardial infarction [72%], no previous infarction [83%]). These factors were also found to be independent predictors of death during the follow-up period by a multivariate stepwise logistic regression analysis. Other factors tested, with no influence on survival, were gender, procedural success and stability of angina at the time of intervention.
The long-term prognosis of patients after coronary angioplasty is good, particularly in those <60 years old with single-vessel disease and normal left ventricular function. The majority of patients are likely to experience a further cardiac event in the 10 years after their first angioplasty procedure.
本研究报告了1980年至1985年间在胸科中心连续接受冠状动脉血管成形术尝试的856例患者的10年随访结果。
冠状动脉球囊血管成形术于1977年首次实施，该手术于1980年引入胸科中心的临床实践。尽管已取得进展，但就生存和主要心脏事件而言，进一步了解长期预后仍然具有重要意义，并且对冠状动脉疾病患者的治疗具有宝贵的指导作用。
通过回顾性研究从荷兰民事登记处、病历中获取生存、心脏事件、症状和用药的详细信息，或通过信件、电话询问患者或其医生，并录入专门的数据库。构建患者生存曲线，并确定影响生存和心脏事件的因素。
手术临床成功率为82%。837例患者（97.8%）获得随访信息。641例患者（77%）存活，其中334例（53%）无症状，254例（40%）未服用抗心绞痛药物。总体5年和10年生存率分别为90%（95%置信区间[CI]87.6%至92.4%）和78%（95%CI75.0%至81.0%），无重大心脏事件（死亡、心肌梗死、冠状动脉搭桥手术和再次血管成形术）的相应比例分别为57%（95%CI53.4%至60.6%）和36%（95%CI32.4%至39.6%）。发现对10年生存有不利影响的因素为年龄≥60岁（≥60岁[67%]，50至59岁[82%]，<50岁[88%]）、多支血管病变（多支血管病变[69%]，单支血管病变[82%]）、左心室功能受损（射血分数<50%[57%]，≥50%[80%]）以及既往心肌梗死病史（既往心肌梗死[72%]，无既往梗死[83%]）。通过多变量逐步逻辑回归分析发现，这些因素也是随访期间死亡的独立预测因素。其他经测试对生存无影响的因素包括性别、手术成功率和干预时心绞痛的稳定性。
冠状动脉血管成形术后患者的长期预后良好，尤其是那些年龄<60岁、单支血管病变且左心室功能正常的患者。大多数患者在首次血管成形术后10年内可能会发生进一步的心脏事件。
