耐火性アンギナ・ペクトリス症の患者におけるトランスミオカルディアルレーザー再血管化後の中期的な臨床結果
C K Landolfo1, K P Landolfo, G C Hughes
1Duke University Medical Center, Departments of Internal Medicine, Surgery, and Radiology, Division of Cardiology, Durham, NC 27710, USA. donov001@mc.duke.edu
Circulation
|November 24, 1999
まとめ
トランスミオカルディアルレーザー再血管化は,末期冠動脈疾患の患者に対して,控えめで持続的なアンギナ緩和を提供します. TMRはSPECT perfusion imagingを改善しなかったが,患者の50%は1年後にアンギナ症状の改善を経験した.
科学分野:
- 心臓病学 心臓病学
- 心血管外科手術についてです.
- 医療技術 医療技術について
背景:
- 耐火性 angina pectorisは,従来の治療法に適合しない患者にとって課題となっています.
- トランスミオカルディアスレーザー再循環 (TMR) は,心筋不全症の代替手術の選択肢です.
- TMR.の長期的な有効性と自然経歴に関するデータは限られている.
研究 の 目的:
- トランスミオカルディアルレーザーリバスカライゼーション (TMR) の中期的な臨床アウトカムを評価する.
- TMR後の耐性アンギナ・ペクトリス患者の臨床改善の持続時間を評価する.
主な方法:
- 重度の冠動脈疾患を有する34人の患者がTMRを受けた.
- 術前SPECT (201) Tl輸血画像を用いて,心筋不全の領域を特定しました.
- 死亡率,心筋梗塞,心筋梗塞のクラス,入院などの臨床結果は,TMR後3,6,12ヶ月で評価されました.
主要な成果:
- 1年間の死亡率は14.7%で,8.8%が非致命的な心筋梗塞を経験しました.
- 平均アンギナクラスは,TMR前の3.5から12ヶ月で2.8に改善した (n=27).
- 患者の50%が1年後にアンギナクラスで持続的な改善を示し,不安定なアンギナのために入院した患者は有意に減少した (P=0.01).
結論:
- トランスミオカルディアンレーザー再血管化は,末期冠動脈疾患の患者の心痛の症状を控えめながらも持続的に改善します.
- 臨床的利益,特に症状の改善は,TMR後6ヶ月でピークに達し,1年後に50%の患者で維持されました.
- SPECT (201) Tl画像は,TMR後の注射の有意な改善を示さなかったため,症状の緩和は非発血的メカニズムによって媒介される可能性があることを示唆している.
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