CORONARY MORPHOLOGICAL AND CLINICAL DETERMINANTS OF PROCEDURAL OUTCOME WITH ANGIOPLASTY FOR MULTIVESSEL CORONARY-DISEASE - IMPLICATIONS FOR PATIENT SELECTION
CORONARY MORPHOLOGICAL AND CLINICAL DETERMINANTS OF PROCEDURAL OUTCOME WITH ANGIOPLASTY FOR MULTIVESSEL CORONARY-DISEASE - IMPLICATIONS FOR PATIENT SELECTION
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DOI：
10.1161/01.cir.82.4.1193
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发表时间：
1990-10-01
期刊：
影响因子：
37.8
通讯作者：
BULLE, TM
中科院分区：
文献类型：
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作者：
ELLIS, SG;VANDORMAEL, MG;BULLE, TM
为了评估接受经皮冠状动脉成形术的多支冠状动脉疾病患者手术成功的可能性，对来自四个临床部位的350名连续患者(1,100个狭窄)进行了评估。18个表征每个狭窄的严重程度和形态的变量和18个与患者相关的变量被作为核心血管造影实验室和临床部位进行评估。大多数患者患有加拿大心血管协会III级或IV级心绞痛(72%)和双支血管冠心病(78%)。左心功能总体上保存良好(平均射血分数，58.5+-)。12%；范围18-85%)和1.9.+-。每名患者有1.0个狭窄曾尝试过经皮冠状动脉成形术。程序成功(.ltoreq.290例(82.8%)患者(82.8%)达到一个或多个狭窄的50%终径狭窄，9例(2.6%)狭窄达到或超过20%，终径狭窄51~60%，无重大并发症。30名患者(8.6%)发生了主要的缺血并发症(死亡、心肌梗死或紧急搭桥手术)。住院死亡率为1.1%。逐步回归分析确定修改的美国心脏病学会/美国心脏协会工作组(ACC/AHA)对主要目标狭窄的分类(B型前瞻性地分为B1型[一种B型特征]和B2型[gtoreq]。两个B型特征])和有无糖尿病是唯一独立预测手术结果的变量(靶狭窄改良的Acc/AHA评分：成功和并发症P<；均为0.001；糖尿病：成功P=0.003，并发症P=0.016)。根据每个狭窄扩张的成功率和并发症分析显示，对于A型狭窄，成功率为92%，并发症发生率为2%；对于B1型狭窄，成功率为84%，并发症发生率为4%；对于B2型狭窄，成功率为76%，并发症发生率为10%；对于C型狭窄，成功率为61%，并发症发生率为21%。与标准的ACC/AHA方案相比，细分为B1型和B2型在这一临床重要的中等风险组中提供了显著更多的信息。慢性完全闭塞、高度狭窄(直径80~99%)、狭窄弯曲程度大于60度、曲度过大的狭窄特征尤其预示着不良的手术结果。这一改进的方案可能会改善临床决策，并提供一个框架，在评估经皮冠状动脉血管成形术疗效的随机试验中进行有意义的亚组分析。
To assess the likelihood of procedural success in patients with multivessel coronary disease undergoing percutaneous coronary angioplasty, 350 consecutive patients (1,100 stenoses) from four clinical sites were evaluated. Eighteen variables characterizing the severity and morphology of each stenosis and 18 patient-related variables were assessed as a core angiographic laboratory and at the clinical sites. Most patients had Canadian Cardiovascular Society class III or IV angina (72%) and two-vessel coronary disease (78%). Left ventricular function was generally well preserved (mean ejection fraction, 58 .+-. 12%; range, 18-85%) and 1.9 .+-. 1.0 stenoses per patient had attempted percutaneous coronary angioplasty. Procedural success (.ltoreq. 50% final diameter stenosis in one or more stenoses and no major ischemic complications) was achieved in 290 patients (82.8%), and an additional nine patients (2.6%) had a reduction in diameter stenosis by 20% or more with a final diameter stenosis 51-60% and were without major complications. Major ischemic complications (death, myocardial infarction, or emergency bypass surgery) occurred in 30 patients (8.6%). In-hospital mortality was 1.1%. Stepwise regression analysis determined that a modified American College of Cardiology/American Heart Association Task Force (ACC/AHA) classification of the primary target stenosis (with type B prospectively divided into type B1 [one type B characteristic] and type B2 [.gtoreq. two type B characteristics]) and the presence of diabetes mellitus were the only variables independently predictive of procedural outcome (target stenosis modified ACC/AHA score: p < 0.001 for both success and complications; diabetes mellitus: p = 0.003 for success and p = 0.016 for complications). Analysis of success and complications on a per stenosis dilated basis showed, for type A stenoses, a 92% success and a 2% complication rate; for type B1 stenoses, an 84% success and a 4% complication rate; for type B2 stenoses, a 76% success and a 10% complication rate; and for type C stenoses, a 61% success and a 21% complication rate. The subdivision into types B1 and B2 provided significantly more information in this clinically important intermediate risk group than did the standard ACC/AHA scheme. The stenosis characteristics of chronic total occlusion, high grade (80-99% diameter) stenosis, stenosis bend of more than 60.degree., and excessive tortuosity were particularly predictive of adverse procedural outcome. This improved scheme may improve clinical decision making and provide a framework on which to base meaningful subgroup analysis in randomized trials assessing the efficacy of percutaneous coronary angioplasty.