Dangas G, Mehran R, Duvvuri S, Vidhun R, Ambrose J A, Sharma S K
Cardiac Catheterization Laboratory, Mount Sinai Cardiovascular Institute, New York, NY 10029, USA.
Cardiology. 1998 Jul;90(1):63-6. doi: 10.1159/000006819.
Balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) is an established common strategy in the treatment of acute myocardial infarction (MI) with high success rates but a 5-10% incidence of reclosure/reinfarction due to thrombus and/or intimal flaps. Directional coronary atherectomy (DCA) by removing plaque/thrombus and achieving larger postprocedural luminal diameter may further decrease the incidence of reclosure/reinfarction, with a resultant better in-hospital outcome in this setting. We analyzed the clinical, procedural and in-hospital outcome of patients who underwent DCA or PTCA within 48 h of MI. Long lesions (>20 mm), large angiographic intracoronary thrombus, lesions in a bend, heavy calcification, and vessel diameter <3.0 mm were excluded from the study. Although slow flow occurred more frequently during DCA (17 vs. 9% during PTCA, p = 0.04), procedural success (<50% final diameter stenosis with TIMI-3 flow) was achieved in 96% of DCA and 92% of PTCA group (nonsignificant). Acute closure occurred in 9% of the PTCA group versus 2% of the DCA (p = 0.05), and the composite endpoint of in-hospital reinfarction, reintervention, bypass surgery or death was present in 9% of PTCA cases versus none of DCA cases (p = 0.03). There were no major peripheral vascular complications requiring surgery in either group. Therefore, DCA appears safe and effective in selected patients with recent MI, and is associated with a low incidence of major clinical complications.
球囊血管成形术（经皮腔内冠状动脉成形术，PTCA）是治疗急性心肌梗死（MI）的一种既定常用策略，成功率高，但由于血栓和/或内膜瓣导致再闭塞/再梗死的发生率为5%-10%。定向冠状动脉斑块旋切术（DCA）通过清除斑块/血栓并在术后获得更大的管腔直径，可能会进一步降低再闭塞/再梗死的发生率，从而在这种情况下改善住院结局。我们分析了在心肌梗死后48小时内接受DCA或PTCA治疗的患者的临床、手术及住院结局。研究排除了长病变（>20mm）、血管造影显示冠状动脉内大血栓、弯曲处病变、严重钙化以及血管直径<3.0mm的情况。尽管DCA期间慢血流更频繁发生（PTCA期间为9%而DCA期间为17%，p = 0.04），但DCA组96%和PTCA组92%的患者手术成功（最终直径狭窄<50%且TIMI-3级血流）（无显著差异）。PTCA组9%发生急性闭塞，而DCA组为2%（p = 0.05），PTCA组9%的患者出现住院期间再梗死、再次干预、搭桥手术或死亡的复合终点事件，而DCA组无一例出现（p = 0.03）。两组均未发生需要手术治疗的严重外周血管并发症。因此，DCA在近期心肌梗死的特定患者中似乎安全有效，且主要临床并发症发生率较低。
