Preisack M B, Elsenberger R, Athanasiadis A, Karsch K R
Med. Klinik III, Univ.-Klinik Tübingen.
Z Kardiol. 1998 Jan;87(1):41-50. doi: 10.1007/s003920050154.
The influence of a coronary dissection on long-term outcome after PTCA has been controversely discussed in the past. Whereas diverse experimental studies have shown a positive relation between dissection and the incidence of restenosis, clinical trials could not document an influence of dissection on long-term outcome. However, most of the trials did not distinguish between the different morphologic configuration of the vascular dissection. Thus, the aim of the present study was to determine the influence of dissections on restenosis in regard to their amount and morphologic configuration. The prognostic importance of the National Heart, Lung, and Blood Institute classification on dissection as well as the importance of an additional classification of angiographic complications after PTCA were investigated to determine possible pathophysiologic mechanisms of the restenosis process. The study included 141 consecutive patients with 143 stable dissections after PTCA. A follow-up study was performed 13 months in mean after successful PTCA, which included clinical, symptomatic, and functional aspects of patients. In this patient population, type C dissections (Dorros et al.) showed a relevantly increased risk of a clinical adverse event (41.0%), whereas patients with a type A dissection had only a small risk of an adverse event (10.0%) over the investigation period. Type B dissections revealed an intermediate risk (18.0%), and type D dissections showed a risk of 33.3% of an adverse event, which was lower than that observed for type C dissections. The AC-classification of the postinterventional coronary morphology was a stronger predictor of an adverse outcome after PTCA (p = 0.0003) than was the Dorros-classification (p = 0.0056).
The grade of a coronary dissection was highly, positively related to an ischemic event after PTCA using both the Dorros and the AC-classification (p = 0.0056/p = 0.0003). In regard to the special association of the AC-class with the amount of vascular injury, we conclude that the amount and configuration of coronary dissection correlates with the long-term outcome after PTCA.
过去关于冠状动脉夹层对经皮冠状动脉腔内血管成形术（PTCA）后长期预后的影响一直存在争议。尽管各种实验研究表明夹层与再狭窄发生率之间存在正相关，但临床试验未能证明夹层对长期预后有影响。然而，大多数试验并未区分血管夹层的不同形态结构。因此，本研究的目的是确定夹层的数量和形态结构对再狭窄的影响。研究了美国国立心肺血液研究所夹层分类的预后重要性以及PTCA后血管造影并发症额外分类的重要性，以确定再狭窄过程可能的病理生理机制。该研究纳入了141例连续的患者，这些患者在PTCA后出现了143处稳定的夹层。在成功进行PTCA后平均13个月进行了随访研究，包括患者的临床、症状和功能方面。在该患者群体中，C型夹层（多罗斯等人分类）显示临床不良事件风险显著增加（41.0%），而在研究期间，A型夹层患者发生不良事件的风险较小（10.0%）。B型夹层显示出中等风险（18.0%），D型夹层显示不良事件风险为33.3%，低于C型夹层观察到的风险。介入后冠状动脉形态的AC分类比多罗斯分类（p = 0.0056）更能预测PTCA后的不良结局（p = 0.0003）。
使用多罗斯分类和AC分类，冠状动脉夹层的分级与PTCA后的缺血事件高度正相关（p = 0.0056/p = 0.0003）。鉴于AC分类与血管损伤量的特殊关联，我们得出结论，冠状动脉夹层的数量和结构与PTCA后的长期预后相关。
