Ambrose J A, Almeida O D, Sharma S K, Dangas G, Ratner D E
Department of Medicine, Mount Sinai Hospital, New York, New York, USA.
Am J Cardiol. 1997 Mar 1;79(5):559-63. doi: 10.1016/s0002-9149(96)00815-6.
The evolution and progression of thrombus and dissection after percutaneous transluminal coronary angioplasty (PTCA) are unknown. As part of the protocol of the Thrombolysis and Angioplasty in Unstable Angina (TAUSA) trial, 1 and 15 minutes post-PTCA angiograms were routinely performed and evaluated by the core laboratory for the presence of thrombus and either minor or major dissection. Thrombus was present at 1 minute in 4.4% of culprit lesions. This increased to 16% at 15 minutes (p < 0.005) and was equally seen in patients receiving both urokinase and placebo. Any dissection was noted in 25.2% at 1 minute versus 30.5% at 15 minutes (p < 0.08), and this trend was mainly related to an increase in major dissection with urokinase at 15 minutes versus 1 minute (10.1% vs 5.9%, respectively, p = 0.10). The in-hospital clinical outcome of patients with lesions that did or did not have thrombus or major dissection at 1 and 15 minutes was retrospectively assessed in the placebo group. The presence of either thrombus or major dissection at 1 minute was associated with a subsequent incidence of acute closure of 14% and an incidence of emergency bypass surgery of 11% (p < 0.01 compared with no thrombus or major dissection at 1 minute). The absence of thrombus and major dissection at 15 minutes (n = 173) was associated with no subsequent acute closure or emergency bypass surgery, (p < 0.05 for acute closure vs thrombus or major dissection at 15 minutes). Thrombus evolves progressively over 15 minutes after PTCA in unstable angina, whereas dissection is usually present immediately after PTCA. The absence of thrombus and major dissection at 15 minutes is associated with very low-acute in-hospital complications. Delayed angiograms following standard balloon angioplasty for unstable angina may be predictive of low complications and our study suggests a possible role for their use.
经皮腔内冠状动脉成形术（PTCA）后血栓形成及夹层的演变和进展尚不清楚。作为不稳定型心绞痛溶栓与血管成形术（TAUSA）试验方案的一部分，在PTCA术后1分钟和15分钟常规进行血管造影，并由核心实验室评估血栓以及轻微或严重夹层的存在情况。4.4%的罪犯病变在术后1分钟出现血栓。这一比例在15分钟时增至16%（p<0.005），且在接受尿激酶和安慰剂的患者中均有出现。术后1分钟有25.2%出现任何夹层，而15分钟时为30.5%（p<0.08），这种趋势主要与15分钟时接受尿激酶治疗的患者严重夹层较1分钟时增加有关（分别为10.1%和5.9%，p = 0.10）。在安慰剂组中，对术后1分钟和15分钟有或无血栓或严重夹层病变的患者的院内临床结局进行了回顾性评估。术后1分钟出现血栓或严重夹层与随后14%的急性闭塞发生率以及11%的急诊搭桥手术发生率相关（与术后1分钟无血栓或严重夹层相比，p<0.01）。术后15分钟无血栓和严重夹层（n = 173）与随后无急性闭塞或急诊搭桥手术相关（急性闭塞与术后15分钟有血栓或严重夹层相比，p<0.05）。不稳定型心绞痛患者PTCA术后15分钟内血栓逐渐形成，而夹层通常在PTCA术后立即出现。术后15分钟无血栓和严重夹层与院内极低的急性并发症相关。不稳定型心绞痛标准球囊血管成形术后延迟血管造影可能预示低并发症，我们的研究表明其使用可能具有一定作用。
