Marzocchi A, Piovaccari G, Marrozzini C, Ortolani P, Palmerini T, Branzi A, Magnani B
Institute of Cardiology, University of Bologna, Italy.
Am J Cardiol. 1997 May 15;79(10):1314-8. doi: 10.1016/s0002-9149(97)00131-8.
Coronary artery stenting has been shown to improve the short- and long-term results of coronary angioplasty in mainly stable patients with 1-vessel disease, but it is uncertain whether its use in an unstable clinical setting may be safe and useful. To evaluate the stenting efficacy in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon expandable stent in 231 consecutive patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent implantation: group U (132 patients) had unstable angina, and group S (99 patients) had stable angina. After stent insertion, patients were treated with anticoagulant or combined antiplatelet therapy. Baseline characteristics of the 2 groups were comparable with the exception of age (higher in the unstable group) and angiographic characteristics of the target lesions (more unfavorable in unstable patients). In both groups, coronary stenting presented a high procedural success rate. Major in-hospital complications occurred in 9 unstable (6.8%) and in 2 stable (2%) patients (p = NS) and were mainly related to subacute stent thrombosis. In both groups, subacute stent thrombosis mostly occurred in patients treated with anticoagulant therapy (7 of 9 unstable patients, 2 of 2 stable patients). At 6-month follow-up, unstable and stable patients had a similar incidence of death (0%), Q-wave myocardial infarction (0%), and need of coronary artery bypass graft (3.2% vs 4%, p = NS), but coronary angioplasty repetition (4.8% vs 14%, p = 0.027) and target vessel revascularization (6.3% vs 17%, p = 0.019) rates were lower in the unstable group. In conclusion, stent insertion increases the short- and midterm coronary angioplasty effectiveness in unstable angina, making it possible to achieve outcomes quite comparable to stable angina. Compared with conventional anticoagulant regimen, combined antiplatelet therapy after placement of coronary stents seems to reduce the incidence of subacute thrombosis also in this clinical setting.
冠状动脉支架置入术已被证明可改善主要为单支血管病变的稳定型患者冠状动脉血管成形术的短期和长期效果，但在不稳定临床情况下使用该技术是否安全且有用尚不确定。为评估不稳定型心绞痛患者的支架置入疗效，我们回顾性分析了连续231例患者使用帕尔马兹-施查茨球囊扩张支架的经验。根据支架置入时的症状将患者分为两组：U组（132例患者）为不稳定型心绞痛，S组（99例患者）为稳定型心绞痛。支架置入后，患者接受抗凝或联合抗血小板治疗。两组的基线特征具有可比性，但年龄（不稳定组较高）和靶病变的血管造影特征（不稳定患者更不利）除外。两组中，冠状动脉支架置入术均具有较高的手术成功率。主要的院内并发症发生在9例不稳定型患者（6.8%）和2例稳定型患者（2%）中（p=无显著性差异），主要与亚急性支架血栓形成有关。两组中，亚急性支架血栓形成大多发生在接受抗凝治疗的患者中（9例不稳定型患者中的7例，2例稳定型患者中的2例）。在6个月的随访中，不稳定型和稳定型患者的死亡发生率（0%）、Q波心肌梗死发生率（0%）以及冠状动脉搭桥术需求率（3.2%对4%，p=无显著性差异）相似，但不稳定组的冠状动脉血管成形术重复率（4.8%对14%，p=0.027）和靶血管血运重建率（6.3%对17%，p=0.019）较低。总之，支架置入可提高不稳定型心绞痛患者冠状动脉血管成形术的短期和中期效果，使其有可能取得与稳定型心绞痛相当的结果。与传统抗凝方案相比，冠状动脉支架置入后联合抗血小板治疗似乎也能降低这种临床情况下亚急性血栓形成的发生率。
