Rupprecht H J, Espinola-Klein C, Erbel R, Nafe B, Brennecke R, Dietz U, Meyer J
Medical Clinic II, Johannes Gutenberg University, Mainz, Germany.
Am Heart J. 1998 Oct;136(4 Pt 1):613-9. doi: 10.1016/s0002-8703(98)70007-9.
There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA).
We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate analysis (Cox model) was performed to identify predictors of adverse events.
During the 10-year follow-up period, 22 (7%) of the 315 patients in group A died, compared with 16 (19%) patients in group B (P= .003). In groups A and B, respectively, acute myocardial infarction occurred in 28 (9%) and 10 (12%) patients (not significant [NS]); coronary artery bypass grafting (CABG) was performed in 42 (13%) and 14 (16%) patients (NS); repeat PTCA was performed in 89 (28%) and 11 (13%) patients (P= .012); and serious adverse events (death, myocardial infarction, CABG) occurred in 76 (24%) and 32 (38%) patients (P= .02). Absence of a 6-month angiographic follow-up was identified as an independent predictor of death associated with a 2.7 times higher mortality rate during the 10-year follow-up period. Previous myocardial infarction increased the risk of death 2.5 times. Any increase of residual diameter stenosis by 10% was combined with a 1.4 times higher mortality rate. The chance of bypass surgery was higher in patients with multivessel disease (2.9 times), in patients with unstable angina (2.1 times), and in case of an increase of residual diameter stenosis by 10% (1.3 times). No predictor for the risk of myocardial infarction was found. Angiographic follow-up increased the likelihood of PTCA 2.5 times.
A routinely performed angiographic control 6 months after successful PTCA is associated with a significantly higher rate of repeat PTCA but, most important, is correlated with a significantly lower mortality rate during the 10-year follow-up period.
对于经皮腔内冠状动脉成形术（PTCA）成功后是否应常规进行重复冠状动脉造影，目前仍存在争议。
我们研究了400例患者的10年预后情况，这些患者在PTCA成功后6个月接受或未接受血管造影检查，且随后6个月无事件发生。我们的比较基于通过问卷调查和电话访谈收集的数据，其中315例患者（A组）进行了常规6个月血管造影检查，85例患者（B组）未进行。采用多变量分析（Cox模型）来确定不良事件的预测因素。
在10年随访期内，A组315例患者中有22例（7%）死亡，而B组85例患者中有16例（19%）死亡（P = 0.003）。在A组和B组中，分别有28例（9%）和10例（12%）患者发生急性心肌梗死（无显著性差异[NS]）；42例（13%）和14例（16%）患者接受了冠状动脉旁路移植术（CABG）（NS）；89例（28%）和11例（13%）患者进行了重复PTCA（P = 0.012）；76例（24%）和32例（38%）患者发生了严重不良事件（死亡、心肌梗死、CABG）（P = 0.02）。未进行6个月血管造影随访被确定为10年随访期内死亡的独立预测因素，死亡率高出2.7倍。既往心肌梗死使死亡风险增加2.5倍。残余直径狭窄每增加10%，死亡率就会增加1.4倍。多支血管病变患者（2.9倍）、不稳定型心绞痛患者（2.1倍）以及残余直径狭窄增加10%的患者（1.3倍）接受搭桥手术的几率更高。未发现心肌梗死风险的预测因素。血管造影随访使PTCA的可能性增加2.5倍。
PTCA成功后常规进行6个月血管造影检查与重复PTCA的发生率显著升高相关，但最重要的是，与10年随访期内显著降低的死亡率相关。
