Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent restenosis.
Repeat percutaneous transluminal coronary angioplasty and predictors of recurrent restenosis.
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重复经皮腔内冠状动脉成形术和复发性再狭窄的预测因素。
DOI：
10.1016/0002-9149(89)90309-3
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
Stack,RS
中科院分区：
文献类型：
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作者：
Quigley,PJ;Hlatky,MA;Hinohara,T;Rendall,DS;Perez,JA;Phillips,HR;Califf,RM;Stack,RS
我们研究了117例连续接受多次经皮腔内冠状动脉成形术（PTCA）的患者，以评估手术成功率和再狭窄复发率。采用逐步逻辑回归分析，检验临床、解剖和手术变量作为再狭窄复发的预测因素。114例（97.5%）患者获得初步成功。1例（0.8%）急性闭塞死亡。没有其他院内并发症。在平均随访时间为218±160天后，114例成功扩张的患者中有72例（63%）没有心绞痛。没有晚期死亡。3例（2.6%）发生晚期心肌梗死。随访100例（88%）患者行动脉造影，其中32%复发性再狭窄（50%管径狭窄）。在单因素分析中，重复PTCA中有3个临床变量的存在与再狭窄发生率显著高于无临床变量相关，即不稳定型心绞痛（48比20%，p = 0.003）、糖尿病（61比26%，p = 0.003）和高血压（46比18%，p = 0.003）。复发性再狭窄患者第一次和第二次PTCA的间隔时间较未专利患者短（136±116天vs 214±163天，p = 0.018）。多因素分析证实不稳定心绞痛、糖尿病和高血压是复发性再狭窄的独立预测因素。重复PTCA可用于再狭窄，成功率高，并发症发生率低。再狭窄复发率与初次血管成形术相似。不稳定型心绞痛、糖尿病和高血压患者出现再狭窄复发的风险较高。
One hundred seventeen consecutive patients undergoing repeat percutaneous transluminal coronary angioplasty (PTCA) were studied to assess procedural success and recurrent restenosis rates. Clinical, anatomic and procedural variables were examined as predictors of recurrent restenosis using stepwise logistic regression analysis. Primary success was achieved in 114 patients (97.5%). One patient (0.8%) died after acute occlusion. No other in-hospital complications were encountered. After a mean follow-up interval of 218 ± 160 days, 72 of 114 successfully dilated patients (63%) remained angina free. There were no late deaths. Three patients (2.6%) experienced a late myocardial infarction. Follow-up arteriography was performed in 100 patients (88%), of whom 32% had recurrent restenosis (>50% luminal diameter narrowing). On univariate analysis, the presence of 3 clinical variables at repeat PTCA was associated with significantly higher recurrent restenosis rates compared with their absence, that is, unstable angina (48 vs 20%, p = 0.003), diabetes (61 vs 26%, p = 0.003) and hypertension (46 vs 18%, p = 0.003). Patients with recurrent restenosis had a shorter interval between first and second PTCA compared with those who remained patent (136 ± 116 vs 214 ± 163 days, p = 0.018). Multivariate analysis confirmed unstable angina, diabetes and hypertension as independent predictors of recurrent restenosis. Repeat PTCA may be performed for restenosis with a high likelihood of success and low incidence of complications. The rate of recurrent restenosis is similar to that reported for initial angioplasty. Patients with unstable angina, diabetes and hypertension appear to be at higher risk for recurrent restenosis.