Madan M, Marquis J F, de May M R, Laramee L A, Leddy D, O'Brien E, Williams W L, Higginson L A, Jelley J, Reid F, Johansen H, Labinaz M
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario.
Can J Cardiol. 1998 Sep;14(9):1109-14.
To examine the procedural and long term success of coronary stenting in patients presenting with unstable angina and the effect of warfarin on the clinical outcome of these high risk patients.
A nonrandomized, retrospective analysis of patients presenting with unstable angina.
A tertiary care, Canadian university-affiliated teaching hospital.
Of 1250 patients who underwent percutaneous transluminal coronary angioplasty between January 1994 and June 1995, 365 underwent coronary stenting. The study population consisted of the 156 patients presenting with unstable angina who underwent coronary stenting. Patients with Canadian Cardiovascular Society class IV and postinfarction angina were included.
Stent delivery by standard techniques to the target lesion was successful in all patients. At discharge, 88 patients were prescribed warfarin, ticlopidine and acetylsalicylic acid (ASA); the remaining 68 patients received only ticlopidine and ASA. Late clinical outcomes were assessed by telephone interview.
The overall procedural success rate was 96%. One patient died in hospital (0.6%). Other events were abrupt closure (1.9%), myocardial infarction (1.9%) and urgent bypass surgery (1.9%). During follow-up, target vessel reintervention was needed in 19.6% of patients. Early and late clinical outcomes did not differ significantly between anticoagulated patients and those treated with antiplatelet agents alone, but anticoagulated patients had a significantly longer hospital stay.
Coronary stenting in patients with unstable angina was associated with excellent procedural success and favourable late clinical outcomes. Warfarin added no apparent additional clinical benefit to antiplatelet agents in this high risk population.
研究不稳定型心绞痛患者冠状动脉支架置入术的手术成功率及长期效果，以及华法林对这些高危患者临床结局的影响。
对不稳定型心绞痛患者进行非随机回顾性分析。
加拿大一所大学附属的三级护理教学医院。
1994年1月至1995年6月间接受经皮腔内冠状动脉成形术的1250例患者中，365例行冠状动脉支架置入术。研究人群包括156例接受冠状动脉支架置入术的不稳定型心绞痛患者。纳入加拿大心血管学会IV级患者及梗死后心绞痛患者。
所有患者均采用标准技术成功将支架置入靶病变部位。出院时，88例患者服用华法林、噻氯匹定和阿司匹林；其余68例患者仅接受噻氯匹定和阿司匹林治疗。通过电话随访评估后期临床结局。
总体手术成功率为96%。1例患者在住院期间死亡（0.6%）。其他事件包括急性血管闭塞（1.9%）、心肌梗死（1.9%）和急诊搭桥手术（1.9%）。随访期间，19.6%的患者需要对靶血管进行再次干预。抗凝治疗患者与单纯接受抗血小板药物治疗患者的早期和晚期临床结局无显著差异，但抗凝治疗患者的住院时间明显更长。
不稳定型心绞痛患者行冠状动脉支架置入术手术成功率高，后期临床效果良好。在这一高危人群中，华法林并未给抗血小板药物带来明显的额外临床益处。
