Versaci F, Gaspardone A, Tomai F, Crea F, Chiariello L, Gioffrè P A
Servizio Speciale di Diagnosi e Cura di Emodinamica, Università di Roma Tor Vergata, Italy.
N Engl J Med. 1997 Mar 20;336(12):817-22. doi: 10.1056/NEJM199703203361201.
Randomized studies have shown that the use of coronary-artery stenting as the initial treatment for coronary stenosis is associated with a lower risk of restenosis than is standard coronary angioplasty. We prospectively investigated the efficacy of these two approaches in selected patients with isolated stenosis of the proximal left anterior descending coronary artery.
A total of 120 patients with isolated stenosis of the proximal left anterior descending coronary artery were randomly assigned to stent implantation or standard coronary angioplasty. The primary clinical end points were the rate of procedural success (defined as residual stenosis of less than 50 percent and the absence of death, myocardial infarction, and the need for coronary-artery bypass surgery during the hospital stay) and the rate of event-free survival (defined as freedom from death, myocardial infarction, and the recurrence of angina) at 12 months. The angiographic end point was the rate of restenosis 12 months after the procedure.
The two treatment groups did not differ significantly with respect to demographic, clinical, or angiographic characteristics. The rates of procedural success were similar in the two groups of patients (95 percent in the stenting group vs. 93 percent in the angioplasty group, P = 0.98). The 12-month rates of event-free survival were 87 percent after stenting and 70 percent after angioplasty (P = 0.04). The rates of restenosis were 19 percent after stent implantation and 40 percent after angioplasty (P = 0.02).
In patients with symptomatic isolated stenosis of the proximal left anterior descending coronary artery, stenting had advantages over standard coronary angioplasty in that it was associated with both a lower rate of restenosis and a better clinical outcome.
随机研究表明，对于冠状动脉狭窄，采用冠状动脉支架置入术作为初始治疗与标准冠状动脉血管成形术相比，再狭窄风险较低。我们前瞻性地研究了这两种方法在选定的孤立性左前降支冠状动脉近端狭窄患者中的疗效。
总共120例孤立性左前降支冠状动脉近端狭窄患者被随机分配接受支架植入或标准冠状动脉血管成形术。主要临床终点为手术成功率（定义为残余狭窄小于50%，且住院期间无死亡、心肌梗死以及无需冠状动脉搭桥手术）以及12个月时无事件生存率（定义为无死亡、心肌梗死和心绞痛复发）。血管造影终点为术后12个月的再狭窄率。
两个治疗组在人口统计学、临床或血管造影特征方面无显著差异。两组患者的手术成功率相似（支架植入组为95%，血管成形术组为93%，P = 0.98）。支架植入后12个月的无事件生存率为87%，血管成形术后为70%（P = 0.04）。支架植入后的再狭窄率为19%，血管成形术后为40%（P = 0.02）。
在有症状的孤立性左前降支冠状动脉近端狭窄患者中，支架置入术优于标准冠状动脉血管成形术，因为它与较低的再狭窄率和更好的临床结局相关。
