Urban P
Cardiologie, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1996 Sep 28;126(39):1661-4.
Surgical or percutaneous revascularisation techniques are increasingly used. Percutaneous angioplasty is more efficient than medical treatment for control of angina symptoms, but it does not influence mortality or infarction in a low-risk population. Surgery is associated with a significant decrease in mortality after 5 years, when compared with a strategy of initial medical treatment. Benefit is maximum in high-risk patients. In selected patients with single- or multivessel disease, several studies have demonstrated that surgery and angioplasty have a similar long-term effect on mortality and/or myocardial infarction. The costs of angioplasty are lower than these of surgery, but the percutaneous approach is limited by a more frequent need for reintervention. In acute myocardial infarction, direct PTCA appears to be associated with a lower mortality than thrombolysis, and hemorrhagic events are less frequent. The cost of an invasive strategy is not necessarily higher than that of medical treatment, because the duration of the initial hospital stay and the need for further hospitalizations are reduced.
外科手术或经皮血管重建技术的应用越来越广泛。经皮血管成形术在控制心绞痛症状方面比药物治疗更有效，但对低风险人群的死亡率或梗死率没有影响。与初始药物治疗策略相比，手术与5年后死亡率的显著降低相关。高危患者受益最大。在选定的单支或多支血管疾病患者中，多项研究表明，手术和血管成形术对死亡率和/或心肌梗死的长期影响相似。血管成形术的费用低于手术，但经皮治疗方法因更频繁需要再次干预而受到限制。在急性心肌梗死中，直接经皮冠状动脉腔内血管成形术（PTCA）似乎比溶栓治疗的死亡率更低，出血事件也更少。侵入性治疗策略的费用不一定高于药物治疗，因为初始住院时间和进一步住院的需求减少了。
