冠状动脉弥漫性长病变介入治疗急性期和远期疗效

目的 :评价经皮冠状动脉腔内成形术治疗弥漫性长病变的急性期和远期疗效。方法 :1997年 9月至 1999年 8月连续 40 3例患者 481处病变行经皮冠状动脉腔内成形术 (PTCA)。依病变长度将患者分为 >2 0mm组 (病变长度 >2 0mm)和≤ 2 0mm组 (病变长度≤ 2 0mm) ,观察手术成功率和并发症发生率。患者每 3～ 4个月门诊随访 1次 ,记录心肌梗塞、各种原因死亡 ,怀疑心肌缺血者再次行冠脉造影 ,如再狭窄 >70 %则再次行靶血管血运重建术 (TLR)。结果 :>2 0mm组和≤ 2 0mm组分别有 10 4和 377处病变 ,2组急性期成功率和并发症发生率均相似。 10 5± 9个月随访中 >2 0mm组TLR患者 (19 4% )明显多于≤ 2 0mm组 (9 3 % ) ,(P <0 0 5 )。 >2 0mm组进一步分析发现 ,病变参照血管直径≤ 3 0mm患者较 >3 0mm患者远期再狭窄和TLR发生率增高。分别为 38 3%、2 9 78%和 2 8 5 %、15 6 % ,(P <0 0 5 )。结论 :与短病变相比 ,经皮冠状动脉腔内成形术治疗弥漫性长病变急性期成功率和并发症相似但远期TLR明显增多。

Prospective registry study of percutaneous reconstr uction for patients with long diffuse lesion

Objective:To assess acute and long-term outcome of stenting for patients with long diffuse coronary lesion.Method:From September 1997 to August 1999,481 lesions of 403 consecutive patients underwent percutaneous transluminal angioplasty.Those with lesion >20 mm in length were classified as >20 mm group and those with lesion ≤20 mm in length as ≤20 mm group.Procedural success rate and complication rate during hospitalization were recorded.Patients were followed up every 3～4 months after the procedure.Follow-up angiography was performed in those who suspected of myocardium ischemia and target lesion revascularization(TLR) was given in those >70% restenosis found.Results:There were 104 cases in >20 mm group and 377 cases in ≤20 mm group.The baseline characteristics were similar in both groups.Compared to the ≤20 mm group,the >20 mm group had similar procedural success rate (94.1% vs.95.2%,respectively)and complication rate (1.92% vs.1.32%,respectively),but more cases in which stents were implanted due to dissection after balloon predilatation(16.2% vs.7.4%),( P <0 05).During an average of 10.5±9 months follow-up,the >20 mm group had higher TLR rate(19.4%)compared to ≤20 mm group 9.3%,( P <0 05).Subgroup analysis of >20 mm group showed that the restenosis rate and TLR rate were higher in those with reference vessel ≤3.0 in diameter(38.3% and 29.78%,respectively)than that in those with >3.0 mm in diameter (28.5%,15.6%,respectively),( P <0 05).Conclusion:Percutaneous transluminal coronary reconstruction in long diffuse lesion had similar acute outcome compared to short lesion,but higher TLR rate and lower event-free survival rate in long-term outcome.