Natural history of patients with single-vessel disease suitable for percutaneous transluminal coronary angioplasty.
Natural history of patients with single-vessel disease suitable for percutaneous transluminal coronary angioplasty.
复制标题
适合经皮冠状动脉腔内成形术的单支血管病变患者的自然史。
DOI：
10.1016/0002-9149(83)90112-1
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
Rosati,RA
中科院分区：
文献类型：
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作者：
Hlatky,MA;Califf,RM;Kong,Y;HarrellJr,FE;Rosati,RA
为了比较经皮腔内冠状动脉成形术（PTCA）与常规治疗，在适合进行PTCA但在该技术可用之前就诊的患者中确定了临床结局。对符合以下标准的患者进行冠状动脉造影检查：单支血管病变伴近端冠状动脉次全狭窄，胸痛至少为II级，1981年之前进行心导管检查。由经验丰富的血管造影师根据PTCA的既定标准评价血管造影片。110例患者（占患者人群的2.1%）被判定适合进行PTCA。临床和导管检查结果与国家PTCA登记处的患者非常相似。导管插入术后5年，97%接受药物治疗的PTCA候选人存活，85%没有心肌梗死。46例患者在导管插入术后6个月内接受了冠状动脉搭桥手术，另外10例患者随后接受了手术。术后5年，91%的患者存活，87%的患者未发生心肌梗死。在6个月的随访中，78%的患者至少改善了1个功能等级，86%的患者在导管插入前仍在工作。在长期随访期间（中位数6.5年，范围1.4 - 12.2），功能能力保持良好。这些数据表明，PTCA候选人有良好的生存预后，梗死风险低，当为药物治疗症状控制不佳的患者保留血运重建时，功能能力保持良好。
To permit comparison of percutaneous transluminal coronary angioplasty (PTCA) with conventional therapy, the clinical outcome was established in patients who would have been suitable candidates for PTCA but who presented before the technique was available. Coronary angiograms were reviewed of patients who met the following criteria: single-vessel disease with proximal subtotal coronary stenosis, chest pain of at least class II, and cardiac catheterization before 1981. Angiograms were evaluated according to established criteria for PTCA by an experienced angiographer. One hundred ten patients (2.1% of the patient population) were judged suitable for PTCA. Clinical and catheterization findings closely resembled those of patients in the national PTCA registry. Five years after catheterization, 97% of PTCA candidates treated medically were alive and 85% had not had myocardial infarction. Forty-six patients had coronary artery bypass surgery within 6 months of catheterization and 10 other patients had subsequent surgery. Five years after surgery, 91% were alive and 87% had not had myocardial infarction. At 6 months of follow-up, 78% of all patients had improved at least 1 functional class, and 86% of all patients working before catheterization were still employed. Functional capacity was well maintained during long-term follow-up (median 6.5 years, range 1.4 to 12.2).These data indicate that PTCA candidates have an excellent prognosis for survival, a low risk of infarction, and well-maintained functional capacity when revascularization is reserved for those with inadequate control of symptoms by medical therapy.