多支冠状动脉病变支架术的疗效及预后

目的:研究多支冠状动脉病变患者支架术的疗效及预后。方法:通过电话或门诊共随访到256例完成经皮冠状动脉介入术(PCI)的冠心病病例。其中单支病变(甲组)104例,多支病变(乙组)152例,乙组又分完全重建组67例和不完全重建组85例,分别比较各组支架术后的长期结果。结果:甲、乙组平均随访时间及手术并发症均无统计学差异。与甲组比较,乙组心绞痛复发率明显增高(P<0.01),再住院率、心脏事件发生率增高,心功能改善率降低(均P<0.05);不完全重建组心脏事件增多(P<0.05),心绞痛复发率及再住院率明显增多、心功能改善率明显减少(均P<0.01)。与完全重建组比较,不完全重建组心绞痛复发率及再住院率增高,心功能改善率减少(均P<0.05)。结论:多支病变患者冠脉内支架术安全,但长期疗效和预后较单支病变差,而病变冠脉完全重建组长期疗效和预后与单支病变相似,显著优于不完全重建组。

Efficacy and prognosis of coronary stenting in patients with multivessel coronary artery disease

Objective:To investigate the efficacy and prognosis of coronary stenting in patients with multivessel coronary artery disease.Methods:A total of 256 patients in whom percutaneous coronary intervention(PCI)was performed successfully were followed up by phone or outpatient interview,and they were divided into 2 groups.Group I included 104 patients with single-vessel coronary stenting,and group II comprised 152 patients with multivessel coronary stenting(67 patients with complete revascularization and 85 with incomplete revascularization).Long-term outcomes were compared between these 2 groups.Results:There were no between-group differences for mean follow-up duration and procedure-related complication rate.Compared with group I,in group II,especially in the patients with incomplete revascularization,the recurrence rate of angina,readmission rate,incidence of cardiac events were significantly higher,and the rate of cardiac function improvement was significantly lower(P<0.05 or P<0.01).In group II,there were statistical differences in recurrence rate of angina,readmission rate,and rate of cardiac function improvement between patients with complete revascularization and incomplete revascularization(all P<0.05).Conclusion:Coronary stenting is safe and effective in patients with multivessel coronary artery disease,but the long-term outcomes and prognosis are worse than those in patients with single-vessel coronary stenting.The outcomes of complete revascularization of multivessel coronary stenting,which are similar to those of single-vessel coronary stenting,are obviously superior to those of incomplete revascularization.