COMPARISON OF COMPLICATIONS DURING PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY FROM 1977 TO 1981 AND FROM 1985 TO 1986 - THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY REGISTRY
COMPARISON OF COMPLICATIONS DURING PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY FROM 1977 TO 1981 AND FROM 1985 TO 1986 - THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY REGISTRY
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DOI：
10.1016/0735-1097(88)92593-4
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发表时间：
1988-11-01
影响因子：
24
通讯作者：
DETRE, K
中科院分区：
文献类型：
--
作者：
HOLMES, DR;HOLUBKOV, R;DETRE, K
由于经皮腔内冠状动脉成形术技术的变化、操作者经验的增加以及在广泛疾病患者中使用该手术的影响在并发症模式方面尚不清楚，国家心脏、肺、心脏病和心血管疾病研究的最初1977-1981年队列和最近1985-1986年队列，和血液研究所经皮腔内冠状动脉成形术登记处的并发症进行了分析。与最初的1,155例患者相比，1,801例新队列患者年龄较大，多支冠状动脉疾病、左心室功能低下和既往梗死的患病率增加。尽管患者人群风险较高，但近期队列的总体并发症发生率与初始队列的发生率相比保持不变或降低。最显著的下降是冠状动脉痉挛的发生率（p < 0.001）和急诊冠状动脉搭桥手术的需要（p < 0.01）。总体住院死亡率较低，但取决于血管病变的程度。单支血管病变为0.2%，双支血管病变为0.9%，三支血管病变为2.2%（线性趋势p < 0.001）。分支闭塞、夹层或突然闭合的急性冠状动脉并发症与死亡、非致命性梗死或急诊手术需求的发生率增加相关。显示与死亡率增加的多变量相关的因素包括充血性心力衰竭史（p < 0.001）、年龄≥ 10岁、年龄≥ 20岁、年龄≥ 20岁、年龄≥ 20岁、年龄≥ 20岁。65岁（P < 0.01）、三支或左主干病变（P < 0.05）、女性（P < 0.05）和新发心绞痛。这些数据支持这样一个概念，即尽管冠状动脉血管成形术用于越来越多的患有更广泛疾病的患者，但其有效性有所改善;然而，该手术具有相关的并发症发生率，尽管很小，但不可忽略。
Because the effects of changing technology in percutaneous transluminal coronary angioplasty, increased operator experience and use of the procedure in patients with extensive disease are unknown in regard to complication patterns, the initial 1977-1981 cohort and the recent 1985-1986 cohort of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry were analyzed with respect to complications. Compared with the initial cohort of 1,155 patients, the 1,801 new cohort patients were older and had an increased prevalence of multivessel coronary artery disease, depressed left ventricular function and prior infarction. Overall complication rates in the recent cohort were either unchanged or decreased from the rates in the initial cohort despite a higher risk patient population. The most significant decreases were in the incidence of coronary spasm (p < 0.001) and the need for emergency coronary bypass surgery (p < 0.01). Overall in-hospital mortality was low but was dependent on the extent of vessel disease.sbd.0.2% for single vessel disease, 0.9% for double vessel disease and 2.2% for triple vessel disease (p < 0.001 for linear trend). Acute coronary complications of branch occlusion, dissection or abrupt closure were associated with increased rates of death, nonfatal infarction or need for emergency surgery. Factors showing a multivariate association with increased mortality included a history of congestive heart failure (p < 0.001), age .gtoreq. 65 years (p < 0.01), triple vessel or left main coronary artery disease (p < 0.05), female gender (p < 0.05) and new onset angina. These data support the concept that, although coronary angioplasty is used in an increased number of patients with more extensive disease, its effectiveness has improved; the procedure, however, has an associated complication rate that, although small, is not negligible.