Reisman M, Harms V, Whitlow P, Feldman T, Fortuna R, Buchbinder M
Swedish Medical Center, Seattle, Washington, USA.
J Am Coll Cardiol. 1997 Feb;29(2):353-7. doi: 10.1016/s0735-1097(96)00478-0.
We compared an early registry of rotational atherectomy with a recent registry to examine the evolution of patient profiles, lesion characteristics and procedural outcomes for patients treated with rotational atherectomy.
With increased experience, the selection of patients and lesions treated with a device matures. This study documents the changes in the application of rotational atherectomy.
The patient characteristics and procedural outcomes from two multicenter patient registries-Registry I: 2,953 procedures, 3,717 lesions from 1988 to 1993; and Registry II: 200 procedures, 268 lesions from 1994-were analyzed and compared.
There was an increase in the average age of the patients (63 vs. 65 years, p < 0.02) and the proportion of patients with unstable angina (42.9% vs. 56.5%, p < 0.01) or previous coronary artery bypass graft surgery (18.8% vs. 24.5%, p < 0.05) in Registry II. Registry II included fewer left anterior descending coronary lesions (46.5% vs. 32.8%, p < 0.01), more type B and C lesions (83.1% vs. 91.8%, p < 0.01), more eccentric lesions (69.0% vs. 79.5%, p < 0.01) and more calcified lesions (50.3% vs. 69.4%, p < 0.01). Complications, including urgent bypass surgery, Q and non-Q wave myocardial infarction, dissection, acute occlusion and perforation, were similar in the two groups. However, mortality increased from 1.0% to 3.0% (p < 0.05) in Registry II.
Comparison of recent and early patients treated with rotational atherectomy revealed an increase in the complexity of patients and lesions. Although the rate of death was increased, the overall rate of major complications was not significantly changed (4.7% vs. 6.0%, p = NS).
我们将早期旋磨术登记资料与近期登记资料进行比较，以研究接受旋磨术治疗患者的患者资料、病变特征及手术结果的演变情况。
随着经验的增加，使用某种器械治疗的患者和病变的选择逐渐成熟。本研究记录了旋磨术应用方面的变化。
分析并比较了两个多中心患者登记资料中的患者特征及手术结果——登记资料I：1988年至1993年的2953例手术、3717处病变；登记资料II：1994年的200例手术、268处病变。
登记资料II中患者的平均年龄有所增加（63岁对65岁，p<0.02），不稳定型心绞痛患者的比例（42.9%对56.5%，p<0.01）或既往接受冠状动脉搭桥手术的患者比例（18.8%对24.5%，p<0.05）也有所增加。登记资料II中左前降支冠状动脉病变较少（46.5%对32.8%，p<0.01），B型和C型病变较多（83.1%对91.8%，p<0.01），偏心病变较多（69.0%对79.5%，p<0.01），钙化病变较多（50.3%对69.4%，p<0.01）。两组的并发症，包括急诊搭桥手术、Q波和非Q波心肌梗死、夹层、急性闭塞和穿孔，相似。然而，登记资料II中的死亡率从1.0%升至3.0%（p<0.05）。
对近期和早期接受旋磨术治疗的患者进行比较发现，患者和病变的复杂性增加。虽然死亡率有所上升，但主要并发症的总体发生率没有显著变化（4.7%对6.0%，p=无统计学意义）。
