Angioï M, Danchin N, Juillière Y, Feldmann L, Berder V, Cuillière M, Buffet P, Anconina J, Cherrier F
Services de cardiologie A et B, CHU Nancy-Brabois, Vandoeuvre-lès-Nancy.
Arch Mal Coeur Vaiss. 1995 Oct;88(10):1383-9.
Percutaneous transluminal coronary angioplasty of chronic total coronary occlusions has a low primary success rate and is associated with a high percentage of restenosis. The aim of this retrospective study was to assess the long-term benefits of these procedures. In a series of 201 patients with 203 chronic total occlusions, the technical success rate was 51%, the clinical success rate was 46% with 3% of major complications. The only factor associated with a favourable outcome was the presumed duration of the occlusion. The clinical follow-up period was established at 6 years. The result of the initial procedure was used to establish two groups of patients: group I, clinical success, and group II, clinical failure. Patients in group I had a probability of survival greater than that of those in group II (97 vs 92%; p < 0.05); survival without coronary bypass surgery was also significantly better (89 vs 74%; p < 0.003). On the other hand, the probability without angioplasty was less in group I (70 vs 77%; p < 0.01), the result of a high restenosis rate (48%). A Cox analysis identified clinical success of angioplasty as a good prognostic factor for survival. Moreover, the clinical status at long-term was significantly better in patients in group I. These results indicate that in patients with chronic total coronary occlusions, the success of angioplasty has a favourable effect on long-term outcome both in terms of survival and in quality of life. They must be interpreted in the light of the limitations inherent in a retrospective study and should be confirmed by prospective trials.
慢性完全性冠状动脉闭塞病变的经皮腔内冠状动脉成形术的初始成功率较低，且再狭窄率较高。这项回顾性研究的目的是评估这些手术的长期益处。在一组201例患有203处慢性完全性闭塞病变的患者中，技术成功率为51%，临床成功率为46%，主要并发症发生率为3%。与良好预后相关的唯一因素是推测的闭塞持续时间。临床随访期设定为6年。根据初始手术结果将患者分为两组：第一组为临床成功组，第二组为临床失败组。第一组患者的生存概率高于第二组（97%对92%；p<0.05）；无冠状动脉搭桥手术的生存率也显著更高（89%对74%；p<0.003）。另一方面，第一组患者未经血管成形术的概率较低（70%对77%；p<0.01），这是高再狭窄率（48%）的结果。Cox分析确定血管成形术的临床成功是生存的良好预后因素。此外，第一组患者的长期临床状况明显更好。这些结果表明，对于慢性完全性冠状动脉闭塞病变患者，血管成形术的成功在生存和生活质量方面对长期预后都有有利影响。这些结果必须结合回顾性研究固有的局限性来解读，并且应该通过前瞻性试验来证实。
