不稳定型与稳定型心绞痛冠状动脉成形术的比较

目的　比较不稳定型心绞痛 (UA)与稳定型心绞痛 (SA)患者接受冠状动脉成形术 (PTCA)的疗效。方法　行PTCA的心绞痛患者 2 0 4例 ,分组比较UA与SA患者冠状动脉造影结果及PTCA术的近期和中期疗效。结果　①分组 :2 0 4例病人中 ,UA组 112例 (5 5 % ) ,SA组 92例 (45 % )。其中UA组心绞痛分级高于SA组 (P <0 0 5 )。②UA组复杂病变血管支数为 74(3 3 % ) ,SA组复杂病变血管 43支(2 0 % ) ,两组比较差异显著 (P <0 0 1) ;而SA组多支血管病变的发生较UA组为多 (P <0 0 5 )。③支架植入情况 :UA组有 114支血管共植入支架 143枚 ,占病变血管数的 5 1% ;SA组 5 4支血管共 67枚 ,占 2 5 % ,两组比较差异显著 (P <0 0 1) ,共 15 6例病人接受支架术。④术后 3 0d内无重大并发症发生 ,UA组复发胸痛较SA组高 (9%vs 3 % ,P <0 0 5 )。⑤随访 3～ 9个月 ,发生心肌梗死 3例 ,其中UA患者2例。复发胸痛两组分别为 12例和 16例 ,占 13 %和 14% ;临床再狭窄发生率分别为 2 0 %和 2 2 % ,均无显著差别。结论　PTCA/支架术对不稳定型与稳定型心绞痛患者的疗效相似 ,即刻成功率高 ,中期疗效满意

Comparison of results of coronary angioplasty in patients with unstable and stable angina

Objective To compare the short and mid term outcomes in cases of percutaneous transluminal coronary angioplasty (PTCA) in patients with unstable and stable angina. Methods Patients selected for PTCA/stenting were divided into two groups, one with stable angina pectoris (SA group, n =92) and another with unstable angina pectoris (UA group, n =112). The outcomes of coronary angiographies (CAG), initial (30 d) success of the procedure, and follow up status in the two groups were compared. Results Baseline characteristics were similar, but the patients with unstable symptoms had more females ( P <0 05), a higher average CCS class ( P <0 05) and a higher incidence of postinfarction angina ( P <0 01). The frequency of "complex" stenosis in UA patients was higher than that of SA patients, (33% vs 20%, P <0 01). A total of 309 vessels accepted the procedure; including 210 stents were successfully delivered to 156 patients. 143 and 67 stents were implanted in the UA and SA group, respectively ( P <0 01). No major complication occurred in the two groups, except 12 patients underwent the reoccurred chest pain initially, 9 in UA group vs 3 in SA group ( P <0 05). The averaged six month follow up status was compared too. Only 3 cases developed myocardial infarction, including 2 patients with unstable angina. 12 and 16 reoccurred chest pains were found in the two groups, respectively (13% in SA group vs 14% in UA group). There were no significant differences between groups in rates of clinical restenosis, follow up angina class, or overall clinical success. Conclusions Patients with unstable angina receiving PTCA/stenting have similar complication, restenosis, and initial and midterm success as compared to patients with stable symptoms with strict cases select and careful preparation and drug therapy.