不稳定的心痛和冠状动脉血管塑造
R K Myler1, R E Shaw, S H Stertzer
1San Francisco Heart Institute, Seton Medical Center, Daly City, Calif 94015.
Circulation
|September 1, 1990
概括
不稳定的心痛患者在冠状动脉血管塑性手术后,与稳定的心痛患者相比,病变更严重,并发症率更高. 不稳定性心痛的早期血管造形与较低的成功率和较高的不良事件有关.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
背景情况:
- 冠状动脉血管造形术是心痛的一个关键干预措施.
- 区分稳定性胸痛 (SAP) 和不稳定性胸痛 (UAP) 的结果对于治疗优化至关重要.
研究的目的:
- 为了比较SAP和UAP患者之间的临床因素,血管整形结果和长期结果.
- 调查症状持续时间对UAP患者血管形成术结果的影响.
主要方法:
- 对2122名接受选择性冠状动脉血管造形手术 (1982-1985) 的患者进行了回顾性分析.
- 在SAP和UAP组之间比较基线特征,程序成功率,并发症率和后续数据 (平均37个月).
- 对UAP患者的亚组分析基于血管塑性术相对于胸痛发作的时间.
主要成果:
- 与SAP患者 (62%) 相比,UAP患者 (38%) 呈现出更严重,更复杂的病变和更高的冠状动脉瘤率.
- 血管整形成功率为UAP的84%,相对于SAP的88% (p<0.05),并发症为UAP的6.7%,相对于SAP的4.7% (p<0.05).
- 在UAP患者中观察到晚期心痛复发 (30.1%vs25.2%) 和较低的返回工作 (86%vs91%). 在UAP中,早期血管造形术 (<1周) 与晚期血管造形术 (≥2周) 相比,表现较低的成功率 (79.1%) 和较高的主要心脏事件 (11.5%) (86.3%的成功率,4.8%的事件).
结论:
- 与SAP患者相比,UAP患者表现出明显的病变形态,并经历较高的并发症率和较差的长期结果.
- 及时干预UAP至关重要,因为延迟血管造形术超过一周可能会改善程序的成功,但由于可能增加不良事件,需要仔细评估风险和益处.
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