Incidence and consequences of periprocedural occlusion. The 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.
Incidence and consequences of periprocedural occlusion. The 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.
复制标题
围手术期闭塞的发生率和后果。
DOI：
10.1161/01.cir.82.3.739
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发表时间：
1990
期刊：
影响因子：
37.8
通讯作者：
Myler,RK
中科院分区：
文献类型：
--
作者：
Detre,KM;HolmesJr,DR;Holubkov,R;Cowley,MJ;Bourassa,MG;Faxon,DP;Dorros,GR;Bentivoglio,LG;Kent,KM;Myler,RK
在1985-1986年经皮腔内冠状动脉成形术（PTCA）登记研究的1，801例患者中，122例（6.8%）发生围手术期闭塞（4.9%在导管室，1.9%在实验室外）。与闭塞率增加独立相关的基线患者因素包括三支血管疾病、手术高危状态和急性冠状动脉功能不全。显示显著正相关的病变特征包括PTCA前重度狭窄、弥漫性或多个离散形态、血栓和病变侧支血流。内膜撕裂和夹层也与闭塞密切相关。60例患者（49%）发生短暂闭塞，经PTCA重新开放，43例（35%）未再扩张并通过旁路手术进行管理，19例（16%）未再扩张并进行药物管理。这些治疗组的住院死亡率均为5%，而无闭塞患者的住院死亡率为1%。住院期间的梗死发生率从短暂性闭塞患者的27%到手术治疗患者的56%不等，而无闭塞患者的发生率为2%。在2年的随访中，闭塞患者的死亡率继续有所增加，而无论闭塞如何，所有患者的随访梗死率都相当。在随访期间，闭塞重新开放或药物治疗的患者手术率增加。短暂性闭塞和无闭塞患者的重复PTCA率相当（2年时约为23%）。闭塞仍然是血管成形术的严重并发症，与住院期间发生的重大事件和外科手术密切相关。
Of 1,801 patients in the 1985-1986 Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry, 122 (6.8%) had periprocedural occlusion (4.9% in the catheterization laboratory, 1.9% outside the laboratory). Baseline patient factors independently associated with increased occlusion rates included triple-vessel disease, high risk status for surgery, and acute coronary insufficiency. Lesion characteristics showing significant positive association included severe stenosis before PTCA, diffuse or multiple discrete morphology, thrombus, and collateral flow from the lesion. Intimal tear and dissection were also very strongly associated with occlusion. Sixty patients (49%) had a transient occlusion that was reopened with PTCA, 43 (35%) were not redilated and managed with bypass surgery, and 19 (16%) were not redilated and managed medically. In-hospital mortality was 5% in each of these treatment groups, compared with 1% in occlusion-free patients. In-hospital infarction rates ranged from 27% in patients with transient occlusion to 56% in the patients managed with surgery, compared with 2% in patients without occlusion. During 2 years of follow-up, somewhat increased mortality continued in patients with occlusion, whereas follow-up infarction rates were comparable for all patients regardless of occlusion. Patients with an occlusion that was reopened or managed medically had increased rates of surgery during follow-up. Rates of repeat PTCA were comparable (about 23% by 2 years) in patients with transient occlusion and those without occlusion. Occlusion remains a serious complication of angioplasty and is associated most strongly with major events and surgical procedures that occur during the in-hospital period.