Zaacks S M, Allen J E, Calvin J E, Schaer G L, Palvas B W, Parrillo J E, Klein L W
Rush-Presbyterian-St. Luke's Medical Center and Rush Heart Institute, Chicago, Illinois 60612, USA.
Am J Cardiol. 1998 Jul 1;82(1):43-9. doi: 10.1016/s0002-9149(98)00239-2.
The goal of this study was to reassess the accuracy of the American College of Cardiology/American Heart Association (ACC/AHA) stenosis morphology classification for predicting coronary intervention success and complications in the era of new devices. Previous studies performed in the early part of this decade for percutaneous transluminal coronary angioplasty in patients with multivessel coronary artery disease found that these criteria were predictive of success rates but not complication rates. Data for 957 consecutive coronary interventions in 1,404 lesions from June 1994 to October 1996 were prospectively classified according to ACC/AHA guidelines and entered into a database. Ninety-one and 9/10 of coronary interventions were successful, defined as <50% residual stenosis of each vessel attempted in the absence of major in-hospital complications, including Q-wave myocardial infarction, ventricular arrhythmia, need for emergency coronary artery bypass surgery, or death. Success rates did not differ between A (186 of 193, 96.3%), B1 (211 of 221, 95.5%), and B2 (676 of 711, 95.1%) lesions, but each was more successful than C (246 of 279, 88.2%) lesions (p <0.003, p < 0.004, and p = 0.0001, respectively). The class of lesion (A, B, or C) did not predict device (atherectomy, rotablator, and stent) use but specific morphologic characteristics of lesions within these classes were predictive of which device was used. Multiple regression analysis revealed that total occlusion and vessel tortuosity were predictive of procedure failure. Lesion type (A, B, or C) was not predictive of complications, but bifurcation lesions (p = 0.0045), presence of thrombus (p = 0.0001), inability to protect a major side branch (p = 0.0468), and degenerated vein graft lesions (p = 0.0283) were predictive. Thus, the ACC/AHA grading system is predictive of successful coronary intervention outcome, particularly of C-type characteristics, but not of complications or device success rate and selection. Although lesion type (A, B, or C) was not predictive of complications, specific lesion morphologies were predictive of adverse events and device use.
本研究的目的是重新评估美国心脏病学会/美国心脏协会（ACC/AHA）狭窄形态学分类在预测新设备时代冠状动脉介入治疗成功率和并发症方面的准确性。在本十年早期对多支冠状动脉疾病患者进行的经皮腔内冠状动脉成形术的既往研究发现，这些标准可预测成功率，但不能预测并发症发生率。根据ACC/AHA指南，对1994年6月至1996年10月期间1404处病变的957例连续冠状动脉介入治疗数据进行前瞻性分类，并录入数据库。919/10的冠状动脉介入治疗成功，定义为在无主要院内并发症（包括Q波心肌梗死、室性心律失常、急诊冠状动脉搭桥手术需求或死亡）的情况下，每支尝试治疗的血管残余狭窄<50%。A类病变（193例中的186例，96.3%）、B1类病变（221例中的211例，95.5%）和B2类病变（711例中的676例，95.1%）的成功率无差异，但每一类病变的成功率均高于C类病变（279例中的246例，88.2%）（p分别<0.003、<0.004和=0.0001）。病变类别（A、B或C）不能预测器械（旋切术、旋磨术和支架）的使用，但这些类别内病变的特定形态学特征可预测所使用的器械。多元回归分析显示，完全闭塞和血管迂曲可预测手术失败。病变类型（A、B或C）不能预测并发症，但分叉病变（p = 0.0045）、血栓存在（p = 0.0001）、无法保护主要分支（p = 0.0468）和退化静脉桥病变（p = 0.0283）可预测并发症。因此，ACC/AHA分级系统可预测冠状动脉介入治疗的成功结果，尤其是C型特征，但不能预测并发症或器械成功率及选择。虽然病变类型（A、B或C）不能预测并发症，但特定的病变形态可预测不良事件和器械使用。
