Halon D A, Merdler A, Flugelman M Y, Shifroni G, Khader N, Shiran A, Shahla J, Lewis B S
Department of Cardiology and Community Medicine, Lady Davis Carmel Medical Center and the Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel.
Am J Cardiol. 1998 Sep 1;82(5):547-53. doi: 10.1016/s0002-9149(98)00413-5.
The study examined the 10-year outcome in a cohort of 227 unselected, consecutive patients (age 58+/-10 years) undergoing coronary balloon angioplasty between 1984 and 1986 and followed in a single cardiac center (Lady Davis Carmel Medical Center registry). In particular, we sought to identify the relative importance of the systemic risk factors diabetes and hypertension and the extent of coronary disease as opposed to procedure-related technical variables, the immediate success of the procedure, or completeness of revascularization. By life-table analysis (99% follow-up), 94% of the patients were alive at 5 years, and 77% at 10 years after angioplasty. Ten-year survival was reduced in patients with diabetes mellitus (59% vs 83%, p = 0.0008), in patients with previous myocardial infarction (68% vs 85%, p = 0.01), in patients with ejection fraction <50% (55% vs 82%, p = 0.005), and in patients with 3-vessel disease (58% vs 84% and 86% for 1- and 2-vessel disease, respectively, p = 0.04). Diabetes mellitus was the major independent predictor of poor survival (adjusted odds ratio 3.1, 95% confidence interval 1.55 to 6.19, p = 0.001). Survival at 10 years was identical in 199 patients in whom angioplasty was complete and in 25 in whom the balloon catheter did not cross the lesion, although bypass surgery was more frequent in the latter group (45% vs 21%, p = 0.001). Incomplete revascularization did not predict poor survival (72% vs 79% with complete angioplasty, p = NS). Event-free survival at 10 years for the whole group was 29%, and 49% of patients survived with no event other than a single repeat angioplasty procedure. Multivessel disease, hypertension, and diabetes mellitus were independent predictors of decreased event-free survival, but incomplete revascularization was not. Thus, long-term outcome after coronary balloon angioplasty was related to diabetes mellitus, systemic hypertension, and extent of coronary disease, but not to the immediate success of the procedure or completeness of revascularization.
该研究调查了1984年至1986年间在单一心脏中心（Lady Davis Carmel医学中心登记处）接受冠状动脉球囊血管成形术的227例未经挑选的连续患者（年龄58±10岁）的10年预后情况。具体而言，我们试图确定全身危险因素糖尿病和高血压以及冠状动脉疾病程度相对于与手术相关的技术变量、手术的即刻成功率或血运重建的完整性的相对重要性。通过寿命表分析（99%随访），94%的患者在血管成形术后5年存活，77%在10年存活。糖尿病患者（59%对83%，p = 0.0008）、既往有心肌梗死的患者（68%对85%，p = 0.01）、射血分数<50%的患者（55%对82%，p = 0.005）以及三支血管病变的患者（58%对单支血管病变的84%和两支血管病变的86%，p = 0.04）的10年生存率降低。糖尿病是生存率低的主要独立预测因素（调整后的优势比为3.1，95%置信区间为1.55至6.19，p = 0.001）。血管成形术完成的199例患者和球囊导管未穿过病变的25例患者的10年生存率相同，尽管后一组患者进行搭桥手术的频率更高（45%对21%，p = 0.0
