Halon D A, Flugelman M Y, Merdler A, Rennert H, Shahla J, Lewis B S
Department of Cardiology, Lady Davis Carmel Medical Center, Technion-IIT, Haifa, Israel.
J Am Coll Cardiol. 1998 Nov 15;32(6):1603-9. doi: 10.1016/s0735-1097(98)00450-1.
We sought to examine completed 10-year survival and event-free survival in patients with stable and unstable angina pectoris treated by coronary balloon angioplasty.
Patients with unstable angina are at increased risk for recurrent acute coronary events.
The study included 208 consecutive patients (133 with stable and 75 with unstable angina pectoris) undergoing angioplasty from 1984 to 1986. The balloon crossed the lesion in 185 patients (121 with stable and 64 with unstable angina pectoris). Angioplasty was performed in patients with unstable angina pectoris 12+/-15 days (median 8) after symptom onset. Patients with unstable angina pectoris were classified retrospectively into Braunwald class I (n=3), class II (n=20), class III (n=28), class B (n=52) and class C (n=12). Follow-up data were obtained from hospital charts, telephone interview and official death certificates where applicable. The study had >80% power to detect a clinically significant 20% difference in survival and a 20% difference in event-free survival between the stable and unstable patient groups.
Despite similar baseline characteristics, early (40-day) mortality was slightly higher in patients with unstable angina (4.7% [3 of 64 patients] vs. 0.8% [1 of 121 patients], p=NS). Long-term outcome was not different, because survival curves were parallel thereafter (10-year survival was 83% for those with stable and 77% for those with unstable angina, p=NS). Survival free of myocardial infarction or coronary artery bypass graft surgery at 10 years was 53% in patients with stable and 47% in patients with unstable angina (p=NS), and survival free of infarction, bypass surgery or repeat angioplasty was 32% for both groups at 10 years. In patients with Braunwald class III unstable angina, 10-year survival was 80%, as compared with 85% in other patients with unstable angina, due to the early hazard (p=NS). Survival and event-free survival were similar in patients who had had a recent myocardial infarction (Braunwald class C) and in patients with acute electrocardiographic changes. Repeat hospital admissions were not more frequent in patients with unstable angina (3.1+/-3.5 vs. 3.0+/-2.6, p=NS).
Ten-year survival and event-free survival were similar in patients with stable and unstable angina pectoris treated by coronary balloon angioplasty, with no evidence of an increased rate of recurrent cardiovascular events in the unstable group.
我们试图研究接受冠状动脉球囊血管成形术治疗的稳定型和不稳定型心绞痛患者的10年总生存率和无事件生存率。
不稳定型心绞痛患者发生复发性急性冠状动脉事件的风险增加。
该研究纳入了1984年至1986年连续接受血管成形术的208例患者（133例稳定型心绞痛患者和75例不稳定型心绞痛患者）。185例患者（121例稳定型心绞痛患者和64例不稳定型心绞痛患者）的球囊通过了病变部位。不稳定型心绞痛患者在症状发作后12±15天（中位数8天）接受血管成形术。不稳定型心绞痛患者根据Braunwald分级法进行回顾性分类，I级（n = 3）、II级（n = 20）、III级（n = 28）、B级（n = 52）和C级（n = 12）。随访数据来自医院病历、电话访谈以及适用时的官方死亡证明。该研究有超过80%的把握度检测到稳定型和不稳定型患者组之间在生存率上有临床显著意义的20%差异以及在无事件生存率上有20%的差异。
尽管基线特征相似，但不稳定型心绞痛患者的早期（40天）死亡率略高（4.7% [64例患者中的3例] 对比0.8% [121例患者中的1例]，p = 无统计学意义）。长期预后并无差异，因为此后生存曲线平行（稳定型心绞痛患者10年生存率为83%，不稳定型心绞痛患者为77%，p = 无统计学意义）。稳定型心绞痛患者10年无心肌梗死或冠状动脉搭桥手术的生存率为53%，不稳定型心绞痛患者为47%（p = 无统计学意义），两组10年无梗死、搭桥手术或重复血管成形术的生存率均为32%。在Braunwald III级不稳定型心绞痛患者中，由于早期风险，10年生存率为80%，而其他不稳定型心绞痛患者为85%（p = 无统计学意义）。近期发生心肌梗死的患者（Braunwald C级）和有急性心电图改变的患者在生存率和无事件生存率方面相似。不稳定型心绞痛患者再次住院的频率并不更高（3.1±3.5对比3.0±2.6，p = 无统计学意义）。
接受冠状动脉球囊血管成形术治疗的稳定型和不稳定型心绞痛患者在10年生存率和无事件生存率方面相似，没有证据表明不稳定型患者组复发性心血管事件的发生率增加。
