Determinants of 2-year outcome after coronary angioplasty in patients with multivessel disease on the basis of comprehensive preprocedural evaluation. Implications for patient selection. The Multivessel Angioplasty Prognosis Study Group.
Determinants of 2-year outcome after coronary angioplasty in patients with multivessel disease on the basis of comprehensive preprocedural evaluation. Implications for patient selection. The Multivessel Angioplasty Prognosis Study Group.
复制标题
基于综合术前评估的多支血管疾病患者冠状动脉成形术后 2 年结果的决定因素。
DOI：
10.1161/01.cir.83.6.1905
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发表时间：
1991
期刊：
影响因子：
37.8
通讯作者：
Vandormael,MG
中科院分区：
文献类型：
--
作者：
Ellis,SG;Cowley,MJ;DiSciascio,G;Deligonul,U;Topol,EJ;Bulle,TM;Vandormael,MG
背景：为了评估接受冠状动脉成形术的多支冠状动脉疾病患者中期无事件生存（无死亡、冠状动脉搭桥手术和心肌梗死）的可能性，我们对来自4个临床地点的350名连续患者进行了仔细评估，并随访了22 +/- 10个月。方法和结果在临床现场评估了8个临床变量，在核心血管造影实验室评估了23个血管造影变量，这些变量描述了冠状动脉狭窄的数量、形态和地形。大多数患者患有加拿大心血管学会III级或IV级心绞痛（72%），双支冠状动脉疾病（68%）和保存良好的左心室功能（平均射血分数58±12%；范围18-85%）。99%的患者完成了随访。2年时，无事件生存率为72%，总生存率为96%，不做搭桥手术的生存率为82%，不做手术的非致死性心肌梗死生存率为96%。顺序Cox比例风险回归分析允许逐步输入变量，这些变量的前瞻性编码为简单、中等复杂性或复杂的无事件生存期，这些变量独立预测的条件是：加拿大心血管学会心绞痛等级低、无糖尿病、无左前降段狭窄近端、狭窄简化风险区域评分总分在15分或以下。在没有IV级心绞痛和这些危险因素的情况下，2年无事件生存率为87%，总生存率为100%。在存在两种或两种以上这些危险因素时，无事件生存率低于50%。结论在这种情况下，认识到不良长期预后的危险因素可以改善临床决策，并为评估冠状动脉成形术疗效的随机试验中有意义的亚组分析提供一个框架。
BACKGROUNDTo assess the likelihood of intermediate-term event-free survival (freedom from death, coronary artery bypass surgery, and myocardial infarction) in patients with multivessel coronary disease undergoing coronary angioplasty, 350 consecutive patients from four clinical sites were carefully evaluated and followed for 22 +/- 10 months.METHODS AND RESULTSEight clinical variables were evaluated at the clinical sites, and 23 angiographic variables describing the number, morphology, and topography of coronary stenoses were evaluated at a core angiographic laboratory. Most patients had Canadian Cardiovascular Society class III or IV angina (72%), two-vessel coronary disease (68%), and well-preserved left ventricular function (mean ejection fraction, 58 +/- 12%; range, 18-85%). Follow-up was complete in 99% of patients. At 2 years, event-free survival was 72%, overall survival was 96%, freedom from bypass surgery was 82%, and freedom from nonfatal myocardial infarction without surgery was 96%. Sequential Cox proportional hazards regression analyses allowing stepwise entry of variables prospectively coded as simple, as of intermediate complexity, or as complex found event-free survival to be independently predicted by low Canadian Cardiovascular Society angina class, no diabetes, no proximal left anterior descending stenoses, and the sum of stenosis simplified risk-territory scores of 15 or less. In the absence of class IV angina and these risk factors, 2-year event-free survival was 87% and overall survival was 100%. In the presence of two or more of these risk factors, event-free survival was less than 50%.CONCLUSIONSRecognition of risk factors for poor long-term outcome in this setting may improve clinical decision making and provide a framework on which to base meaningful subgroup analyses in randomized trials assessing the efficacy of coronary angioplasty.