Miyazaki S, Nakao K, Daikoku S, Itoh A, Miyao Y, Goto Y, Nonogi H
Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan.
Cathet Cardiovasc Diagn. 1998 Mar;43(3):262-70. doi: 10.1002/(sici)1097-0304(199803)43:3<262::aid-ccd5>3.0.co;2-7.
This study evaluated the correlation of residual stenosis after percutaneous transluminal coronary angioplasty with the long-term prognosis. Among consecutive 1,230 patients who underwent coronary angioplasty in the National Cardiovascular Center in Osaka, Japan, 894 patients had de novo lesions. Of these, the 70 patients with acute myocardial infarctions and 105 with unstable angina who had emergency coronary angioplasties were excluded from the study. Among the remaining 719 patients, successful dilatation of the main target vessel was achieved in 592 patients, who then comprised the study group. They were divided into three groups according to their residual stenosis (RS) immediately after coronary angioplasty: group A, RS < 15% (n=208); group B, 15% < or = RS < or = 35% (n=286), and group C, 35% < RS < 50% (n=98). The duration of follow-up was 1,668, 1,660, and 1,680 days in group A, B, and C, respectively. The groups A, B, and C were not significantly different in terms of age, history of myocardial infarction, left ventricular ejection fraction, number of diseased vessels and target vessels, and risk factors such as hypertension, hyperlipidemia, and diabetes mellitus. Primary end point of follow-up was defined as death from any cause and the second end point was occurrence of cardiac events. Kaplan-Meier survival analysis showed significant differences among the three groups. Moreover, survival curves seem to be dependent on the degree of post-procedural residual stenosis. Multivariate analysis using a Cox proportional hazard regression model showed that age, ejection fraction, and residual stenosis were independent determinants of event-free, cardiac, and total survival. Residual stenosis immediately after coronary angioplasty is an independent contributor to long-term clinical prognosis in patients treated with successful balloon coronary angioplasty.
本研究评估了经皮腔内冠状动脉成形术后残余狭窄与长期预后的相关性。在日本大阪国立心血管中心连续接受冠状动脉成形术的1230例患者中，894例为新发病变。其中，70例急性心肌梗死患者和105例不稳定型心绞痛患者接受了急诊冠状动脉成形术，被排除在研究之外。在其余719例患者中，592例主要靶血管成功扩张，这些患者组成了研究组。根据冠状动脉成形术后即刻的残余狭窄（RS）情况，将他们分为三组：A组，RS<15%（n = 208）；B组，15%≤RS≤35%（n = 286），C组，35%<RS<50%（n = 98）。A、B、C组的随访时间分别为1668天、1660天和1680天。A、B、C组在年龄、心肌梗死病史、左心室射血分数、病变血管和靶血管数量以及高血压、高脂血症和糖尿病等危险因素方面无显著差异。随访的主要终点定义为任何原因导致的死亡，次要终点为心脏事件的发生。Kaplan-Meier生存分析显示三组之间存在显著差异。此外，生存曲线似乎取决于术后残余狭窄的程度。使用Cox比例风险回归模型进行的多因素分析表明，年龄、射血分数和残余狭窄是无事件生存、心脏生存和总生存的独立决定因素。冠状动脉成形术后即刻的残余狭窄是成功进行球囊冠状动脉成形术治疗的患者长期临床预后的独立影响因素。
