Moret C, Eeckhout E, Burnand B, Vogt P, Stauffer J C, Hurni M, Fischer A, Ruchat P, Kappenberger L, Goy J J
Division de cardiologie, Institut de médecine sociale et préventive, centre hospitalier universitaire Vaudois, Lausanne, Suisse.
Arch Mal Coeur Vaiss. 1998 Dec;91(12):1453-8.
The authors report the results of 5 years follow-up of 134 patients who benefited from percutaneous transluminal coronary angioplasty 5PTCA) or surgical intervention with implantation of the internal mammary artery as treatment of an isolated lesions of the proximal left anterior descending artery with normal left ventricular function. Sixty-eight patients underwent PTCA (group 1) and 66 had surgical bypass (group 2). The demographic data of the two groups was comparable. The incidence of the following events was analysed: death, myocardial infarction, indication for further revascularisation and functional class. At 5 years, the global mortality was 6% (8% in group 1 and 2% in group 2) but cardiac mortality was only 1% (1 patient in each group). The cumulative incidence of myocardial infarction was higher after angioplasty (15% vs 5%) but was mainly related to acute occlusions or acute coronary syndromes during angioplasty. However, the incidence of Q wave infarction was similar in the two groups. During follow-up, 32 patients (26 in group 1 and 6 in group 2) required one or more additional revascularisation procedures of the left anterior descending or of another artery. The proportion of asymptomatic patients at 5 years was high and similar in both groups. Finally, the proportion of patients without events during follow-up was 56% in group 1 and 86% in group 2. Despite the risk of restenosis and reoperation associated with angioplasty, this technique is an acceptable therapeutic alternative to surgical revascularisation in patients with isolated stenosis of the left anterior descending artery. Therefore, the therapeutic decision depends on the individual case, the availability of treatment and the patient's preference during consultation.
作者报告了134例患者的5年随访结果，这些患者因左前降支近端孤立性病变且左心室功能正常，接受了经皮腔内冠状动脉成形术（PTCA）或采用植入乳内动脉的手术干预进行治疗。68例患者接受了PTCA（第1组），66例接受了外科搭桥手术（第2组）。两组的人口统计学数据具有可比性。分析了以下事件的发生率：死亡、心肌梗死、再次血运重建指征和心功能分级。5年时，总体死亡率为6%（第1组为8%，第2组为2%），但心脏死亡率仅为1%（每组各1例患者）。血管成形术后心肌梗死的累积发生率较高（15%对5%），但主要与血管成形术中的急性闭塞或急性冠状动脉综合征有关。然而，两组Q波梗死的发生率相似。随访期间，32例患者（第1组26例，第2组6例）需要对左前降支或其他动脉进行一次或多次额外的血运重建手术。两组5年时无症状患者的比例都很高且相似。最后，随访期间无事件发生的患者比例在第1组为56%，在第2组为86%。尽管血管成形术存在再狭窄和再次手术的风险，但对于左前降支孤立性狭窄的患者，该技术是外科血运重建可接受的治疗替代方案。因此，治疗决策取决于个体情况、治疗的可及性以及咨询时患者的偏好。
