冠心病左心功能不全介入治疗的近期和远期疗效

目的　评价PTCA结合支架治疗冠心病左室功能不全的近期、远期疗效。方法　连续 74例冠心病合并左室射血分数≤ 4 0 %行PTCA治疗 ,其中 6 1例 (81% )在支架支持下进行 ,所有治疗成功者随诊 2 9 1± 2 2 9月。结果　PTCA结合支架治疗的病变成功率为 89 5 % (12 0 /134) ,病例成功率为 89 2 % (6 6 /74 ) 围术期病死率为1 4 % ,心肌梗塞发生率为 2 7% ,无 1例需行急诊冠状动脉搭桥术。 4 4例合并心力衰竭治疗成功者 ,2 9例 (73% )术后 6月NYHA分级下降≥ 1。长期随诊期间 ,5 8例 (87 9% )治疗成功者存活 ,其中 4 4例 (6 8 6 )无任何心脏事件存活。结论　PTCA结合支架治疗冠心病左心功能不全的成功率高 ,围手术期死亡率低 ,远期生存率高。

Stent supported coronary angioplasty in patients with severe ventricular dysfunction

Objective To assess the immediate- and long-term outcomes of stent supported coronary angioplasty in patients with severe left ventricular dysfunction. Methods Seventy-four consecutive patients with angiographic left ventricular ejection fractions ≤40% underwent percutaneous coronary angioplasty, including 61 (81%) with stent back-up. Clinical follow-up (29.1±22.9 months) data were obtained in all clinically successful patients. Results Angiographic success was achieved in 120 (89.5%) of 134 lesions. Clinical success was obtained in 66 (89.2%) patients with 1.4% procedure related mortality, 2.7% myocardial infarction and zero need of emergent bypass surgery. NYHA class reduction ≥1 was seen in 29 (73%) of 40 successfully treated congestive heart failure patients at 6 months after the procedure. During long-term follow-up, 58 (87.9%) of 66 patients with clinical success were alive, including 44 (68.6%) free from cardiac events. Conclusions Patients with severe left ventricular dysfunction treated with stent supported PTCA experience a high rate of success, low procedure related mortality and satisfactory long-term survival.