Waldecker B, Waas W, Haberbosch W, Voss R, Heizmann H, Tillmanns H
Medizinische Klinik I, Zentrum Innere Medizin, Justus-Liebig University, Giessen, Germany.
J Am Coll Cardiol. 1998 Nov;32(5):1320-5. doi: 10.1016/s0735-1097(98)00405-7.
The purpose of this study was to analyze long-term follow-up information over several years from consecutive, unselected patients treated with direct percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (MI).
Direct PTCA is often used in patients with acute MI. Short-term results are favorable. However, there is less information available on long-term observations over several years in these patients.
A total of 416 consecutive and unselected patients with acute MI underwent direct PTCA. Survival of the acute infarct phase was 94.2%; the remaining 392 patients--the study population-were discharged and followed for 3.3+/-1.4 years. Mortality as well as cardiac events and reinterventions are reported. Clinical variables assessed at the time of discharge are submitted to statistical analysis to detect potential risk factors.
Total cumulative mortality in the first year was 10% for the entire group and 6% for patients not presenting in cardiogenic shock. Mortality after discharge was 4.6% in the first year and dropped to <4% per year thereafter. Reinterventions after discharge were required in 16% in the first year and in <4% per year in years 2 to 4. Poor left ventricular ejection fraction (<35%), three-vessel disease and advanced age (> or =75 years) were long-term risk factors for total mortality after direct PTCA.
The clinical benefit of direct PTCA for acute MI is maintained during follow-up with respect to mortality. However, reinterventions for restenosis or de novo stenosis are often required (10% to 20%). Although few in number (<10%), patients with severely impaired left ventricular function continue to have a poor prognosis.
本研究旨在分析连续入选的因急性心肌梗死（MI）接受直接经皮腔内冠状动脉成形术（PTCA）治疗的患者数年的长期随访信息。
直接PTCA常用于急性MI患者。短期结果良好。然而，关于这些患者数年的长期观察资料较少。
共有416例连续入选的急性MI患者接受了直接PTCA。急性梗死期的生存率为94.2%；其余392例患者（研究人群）出院并随访3.3±1.4年。报告死亡率、心脏事件和再次干预情况。对出院时评估的临床变量进行统计分析以检测潜在危险因素。
整个组第一年的总累积死亡率为10%，非心源性休克患者为6%。出院后第一年的死亡率为4.6%，此后每年降至<4%。出院后第一年需要再次干预的比例为16%，第2至4年每年<4%。左心室射血分数低（<35%）、三支血管病变和高龄（≥75岁）是直接PTCA后总死亡率的长期危险因素。
直接PTCA对急性MI的临床益处随访期间在死亡率方面得以维持。然而，常需要因再狭窄或新生狭窄进行再次干预（10%至20%）。尽管数量很少（<10%），但左心室功能严重受损的患者预后仍然较差。
