经皮冠状动脉腔内成形术及置入支架的长期预后分析

目的探讨经皮冠状动脉腔内成形术（PTCA）和PTCA＋支架治疗对我国冠心病患者的远期疗效。方法对1986年12月～1998年6月期间在我院接受PTCA和PTCA＋支架治疗的938例冠心病患者中的790例进行了随访，随访率84.2%。随访方式包括门诊随访和信访。随访时间为0.9－12.7(3.5±2.4)年。结果随访期中死亡4例(0.5%),非致命性急性心肌梗死22例(2.8%)，重复PTCA98例(12.4%)，行冠状动脉旁路移植术10例(1.3%)。以Kaplan-Meier法计算术后12年的生存率为99.5%,无心脏事件生存率1年为88.2%，12年为80.6%。Cox回归分析显示，陈旧性心肌梗死病史和是否放置支架与心脏事件呈负相关，而病变支数与心脏事件正相关。与单纯PTCA组比较，PTCA＋支架组急性心肌梗死发生率和再次PTCA率均显著降低。结论PTCA、特别是PTCA＋支架治疗对我国冠心病患者有良好的疗效，可作为血管重建治疗的首选方法。

ong-term prognosis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective　To evaluate long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA), coronary stenting and to assess the factors affecting the efficacy. Methods　Seven hundred and ninety patients who underwent successful PTCA and PTCA + stent in this hospital were followed up by direct interview or letter. The follow-up rate was 84.2%. The follow-up period was 0.9－12.7 (3.5±2.4) years. Results　During follow-up period, 4 (0.5%) patients died, 22 (2.8%) had nonfatal acute myocardial infarction, 98 (12.4%) had repeat PTCA and 10 (1.3%) had coronary artery bypass surgery. The rate of recurrent angina pectoris was 31.1%. The cardiac event-free survival rate calculated by Kaplan-Meier method was 88.2% in 1 year and 80.6% in 12.7 years. Cox regression analysis showed that there was a positive correlation between old myocardial infarction history, implanting stents and risks of cardiac events, and there was a negative correlation between number of diseased arteries and risks of cardiac events. The rate of cardiac events in PTCA + stent group was much lower than that in PTCA group. Conclusion　The long-term efficacy of PTCA, especially PTCA + stent in Chinese patients is very satisfactory. It is suggested that PTCA + stent should be the first choice of revascularization for patients with coronary heart disease.