Bauters C, Lablanche J M, Van Belle E, Niculescu R, Meurice T, Mc Fadden E P, Bertrand M E
Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille, France.
Circulation. 1997 Nov 4;96(9):2854-8. doi: 10.1161/01.cir.96.9.2854.
PTCA of an infarct-related lesion is associated with a high rate of restenosis and/or vessel occlusion. Recent studies have shown that coronary stenting in patients with stable or unstable angina is associated with a significant reduction in the restenosis rate compared with conventional balloon angioplasty. However, no information is available concerning the long-term effect of coronary stenting at infarct-related lesions compared with balloon angioplasty alone.
One hundred consecutive patients undergoing stent implantation at an infarct-related lesion and systematic 6-month angiographic follow-up were matched for major pre-PTCA clinical and angiographic variables with a group of patients undergoing conventional angioplasty. Preprocedural, postprocedural, and 6-month follow-up angiograms were analyzed with quantitative angiography. Coronary stenting was performed as a bailout procedure after failed balloon angioplasty in 20%, for a suboptimal result after balloon angioplasty in 71%, and electively in 9%. Stent implantation was associated with a higher acute gain than balloon angioplasty. At follow-up, the minimal lumen diameter was significantly (P<.0001) larger in the stent group (1.72+/-0.69 versus 1.23+/-0.72 mm). Restenosis (>50% DS at follow-up) occurred in 27% of the stent group versus 52% of the balloon group (P<.005). At follow-up, total occlusion at the dilated site occurred in 1% of the stent group versus 14% of the balloon group (P<.005).
Coronary stenting of infarct-related lesions is associated with a highly beneficial effect on 6-month angiographic outcome compared with balloon angioplasty alone. Further studies are needed to establish whether the beneficial effect of coronary stenting on long-term vessel patency is associated with an improvement in left ventricular function or in clinical outcome.
梗死相关病变的经皮冠状动脉腔内血管成形术（PTCA）与较高的再狭窄率和/或血管闭塞率相关。近期研究表明，与传统球囊血管成形术相比，稳定型或不稳定型心绞痛患者行冠状动脉支架置入术可使再狭窄率显著降低。然而，与单纯球囊血管成形术相比，关于冠状动脉支架置入术对梗死相关病变的长期影响尚无相关信息。
连续100例在梗死相关病变处接受支架置入术并进行系统6个月血管造影随访的患者，根据PTCA术前主要临床和血管造影变量与一组接受传统血管成形术的患者进行匹配。术前、术后及6个月随访血管造影采用定量血管造影分析。20%的患者在球囊血管成形术失败后作为补救措施进行冠状动脉支架置入，71%的患者因球囊血管成形术后效果欠佳进行置入，9%的患者为选择性置入。支架置入术与比球囊血管成形术更高的急性血管增益相关。随访时，支架组的最小管腔直径显著更大（P<0.0001）（1.72±0.69对1.23±0.72mm）。支架组27%发生再狭窄（随访时直径狭窄>50%），而球囊组为52%（P<0.005）。随访时，扩张部位完全闭塞在支架组为1%，而球囊组为14%（P<0.005）。
与单纯球囊血管成形术相比，梗死相关病变的冠状动脉支架置入术对6个月血管造影结果有高度有益的影响。需要进一步研究以确定冠状动脉支架置入术对长期血管通畅的有益作用是否与左心室功能或临床结局的改善相关。
