Antoniucci D, Santoro G M, Bolognese L, Leoncini M, Buonamici P, Valenti R, Fazzini P F
Division of Cardiology, Careggi Hospital, Florence, Italy.
Coron Artery Dis. 1996 Jan;7(1):75-80.
Percutaneous transluminal coronary angioplasty (PTCA) results in a higher complication rate in patients with unstable angina pectoris than in patients with stable angina. The current management approach is directed towards achieving stabilization by medical treatment in order to reduce the rate of major complications, but the value of a conservative strategy has not been proved by clinical trials, nor has the duration of therapy been established. On the other hand, the definition of unstable angina encompasses a heterogeneous spectrum of patients with different prognoses. It is more appropriate to stratify patients according to different risk in order to evaluate the results of different therapeutic strategies. The purpose of this study was the evaluation of the results of early and delayed coronary angioplasty in patients with high-risk unstable angina.
We compared immediate and follow-up results of early and delayed coronary angioplasty in a series of 263 patients with high-risk unstable angina because of prolonged (more than 15 min) angina or early post-infarction angina at rest. Early PTCA (within 4 h of the last ischaemic episode) was performed in 110 patients with unstable angina refractory to maximized medical treatment, whereas 153 patients with stabilized angina underwent delayed PTCA (at more than 72 h and less than 1 week from the last ischaemic episode).
No significant differences between the two groups were found in primary lesion success rates (92.7% compared with 94.1%), major in-hospital adverse events such as reocclusion (5.4% compared with 2.6%), emergency coronary artery surgery (1.8% compared with 3.2%), myocardial infarction (3.6% compared with 2.6%) and death (1.8% compared with 0.7%). The rates of major adverse events during 6 months follow-up were similar in the two groups: recurrent ischaemia (13.4% compared with 19.7%), repeat coronary angioplasty (11.5% compared with 14.9%), coronary artery surgery (1.9% compared with 4.7%), myocardial infarction (0), and death (0).
The results of this study suggest that an aggressive coronary angioplasty strategy in patients with high-risk unstable angina may result in a favourable outcome both immediately and at 6 months' follow-up, The achievement of a stabilization period seems neither to improve the clinical success rates nor to reduce major cardiac event rates.
经皮腔内冠状动脉成形术（PTCA）在不稳定型心绞痛患者中的并发症发生率高于稳定型心绞痛患者。目前的治疗方法旨在通过药物治疗实现病情稳定，以降低主要并发症的发生率，但保守策略的价值尚未得到临床试验的证实，治疗持续时间也未确定。另一方面，不稳定型心绞痛的定义涵盖了预后不同的异质性患者群体。根据不同风险对患者进行分层，以评估不同治疗策略的效果更为合适。本研究的目的是评估高危不稳定型心绞痛患者早期和延迟冠状动脉成形术的效果。
我们比较了263例因持续性（超过15分钟）心绞痛或心肌梗死后早期静息性心绞痛而患有高危不稳定型心绞痛患者的早期和延迟冠状动脉成形术的即刻和随访结果。110例经最大程度药物治疗仍难治的不稳定型心绞痛患者接受了早期PTCA（在最后一次缺血发作后4小时内），而153例病情稳定的心绞痛患者接受了延迟PTCA（在最后一次缺血发作后72小时以上且不到1周）。
两组在主要病变成功率（分别为92.7%和94.1%）、住院期间主要不良事件如再闭塞（分别为5.4%和2.6%）、急诊冠状动脉手术（分别为1.8%和3.2%）、心肌梗死（分别为3.6%和2.6%）及死亡（分别为1.8%和0.7%）方面均未发现显著差异。两组在6个月随访期间的主要不良事件发生率相似：复发缺血（分别为13.4%和19.7%）、再次冠状动脉成形术（分别为11.5%和14.9%）、冠状动脉手术（分别为1.9%和4.7%）、心肌梗死（均为0）及死亡（均为0）。
本研究结果表明，高危不稳定型心绞痛患者积极的冠状动脉成形术策略在即刻及6个月随访时均可获得良好预后。实现病情稳定期似乎既不能提高临床成功率，也不能降低主要心脏事件发生率。
