Hasdai D, Berger P B, Bell M R, Rihal C S, Garratt K N, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn., USA.
Arch Intern Med. 1997 Mar 24;157(6):677-82.
Devices designed to facilitate or replace conventional percutaneous transluminal coronary angioplasty have been introduced in recent years.
To characterize the changes in percutaneous coronary interventional practice over 16 years and to assess the relative use of these new devices.
We performed a retrospective analysis of all patients who underwent percutaneous coronary revascularization at Mayo Clinic, Rochester, Minn, during a 16-year period (1980-1995) and characterized the changes in procedural and clinical factors.
The number of coronary interventional procedures performed increased from 38 in 1980 to 1284 in 1995. Atherectomy and laser angioplasty were incorporated in 1988; their use peaked in 1994 (17% of procedures) but decreased to 9.9% by 1995. In contrast, the use of intracoronary stents has increased steadily since 1990. By 1995, intracoronary stents were placed in 48.2% of procedures. The success rate improved from 55.3% in 1980 to 91.4% in 1995, although patients were older (51 +/- 10 [mean +/- SD] years in 1980 vs 63 +/- 12 years in 1995), had more extensive coronary artery disease (0% with multivessel disease in 1980 vs 47.4% in 1995), had more complex lesions, and often underwent intervention in the peri-infarction setting (2.6% of procedures in 1980 vs 17% in 1995). The rate of referral to emergency coronary bypass surgery after percutaneous procedures declined from 5.2% in 1980 to 0.4% in 1995.
Current coronary interventional practice is expanding and improving. In contrast to intracoronary stents that have greatly affected current practice, other new devices are used infrequently. Conventional angioplasty, with or without intracoronary stents, remains the dominant treatment strategy.
近年来已引入旨在促进或取代传统经皮腔内冠状动脉成形术的器械。
描述16年间经皮冠状动脉介入治疗实践的变化，并评估这些新器械的相对使用情况。
我们对明尼苏达州罗切斯特市梅奥诊所16年间（1980 - 1995年）接受经皮冠状动脉血运重建的所有患者进行了回顾性分析，并描述了手术和临床因素的变化。
冠状动脉介入手术的数量从1980年的38例增加到1995年的1284例。旋切术和激光血管成形术于1988年被纳入；它们的使用在1994年达到峰值（占手术的17%），但到1995年降至9.9%。相比之下，自1990年以来冠状动脉内支架的使用稳步增加。到1995年，48.2%的手术使用了冠状动脉内支架。成功率从1980年的55.3%提高到1995年的91.4%，尽管患者年龄更大（1980年为51±10[平均±标准差]岁，1995年为63±12岁），患有更广泛的冠状动脉疾病（1980年多支血管病变为0%，1995年为47.4%），病变更复杂，且常在心肌梗死周围环境中接受介入治疗（1980年占手术的2.6%，1995年为17%）。经皮手术后紧急冠状动脉搭桥手术的转诊率从1980年的5.2%降至1995年的0.4%。
当前冠状动脉介入治疗实践正在扩大和改善。与对当前实践有极大影响的冠状动脉内支架不同，其他新器械使用较少。传统血管成形术，无论有无冠状动脉内支架，仍然是主要的治疗策略。
