1985年～1994年与1995年～1997年期间冠心病介入治疗的对比研究(摘要)

中国循环杂志 1999年第0期第14卷 摘要　冠心病介入治疗

作者：李成祥　贾国良　郭文怡　李伟杰　陈士良　张玉顺

单位：陕西省西安市，中国人民解放军第四军医大学西京医院　心内科(710032)

　　目的：调查研究1985年～1997年期间冠心病介入治疗的演变。

　　方法：回顾性分析比较西京医院1985年～1994年与1995年～1997年期间所有行冠心病介入治疗病历完整患者的临床资料。

　　结果：早期病例109例，近期266例，近期病例组年龄增大(58±10比54±11,P＜0.05),不稳定性心绞痛(72%比59%,P＜0.05),多支病变(66%比59%,P＜0.05),B、C型复杂病变(81%比63%，P＜0.05)增加，支架应用普遍(6.4%比2.7%,P＜0.01)。但介入治疗病例(90%比83%,P＜0.05)、病变(91%比80%,P＜0.05)成功率提高，治疗后残余狭窄减轻［(6±14)%比(27±12)%,P＜0.01］,住院期间严重并发症发生率下降(3.0%比6.4%,P＜0.25),死亡(1.5%比3.7%,P＜0.25)、Q波心肌梗塞(1.9%比4.6%,P＜0.25)、死亡或Q波心肌梗塞(2.6%比6.4%,P＜0.10)均降低，球囊扩张后急性闭塞发生率不变(4.5%比4.6%,P=NS)。

　　结论：随着经验积累，例数增多和支架的广泛应用，冠心病介入治疗的适应证扩大，成功率提高，严重并发症发生率下降。但由于年手术量仍偏少，介入治疗的水平仍需进一步提高。

Comparison of Percutaneous Transluminal Coronary Revascularization in 1985～1994 Versus 1995～1997 (Abstract)

Department of Cardiology, PLA, Xijing Hospital, Fourth Military Medical University, Xi′an (710032), Shaanxi

　　Li Chengxiang, Jia Guoliang, Guo Wenyi, et al.

　　Objective: To investigate the evolution of percutaneous transluminal revascularization in a medical center from 1985 to 1997.

　　Methods: In this retrospective study, 109 consecutive treated patients with complete data in Xijing Hospital during 1985～1994 were studied and compared with 266 patients during 1995～1997.

　　Results: The new cohort of patients was older (58±10 vs. 54±11 years, p＜0.05), and had a significantly higher proportion of unstable angina (72% vs. 59%, p＜0.05), multivessel disease (66% vs. 59%, p＜0.05), and complex lesions (type B and C: 81% vs. 63%, p＜0.05). Intracoronary stenting was more widely used in the new cohort (64% vs. 2.7%, p＜0.01). Despite these differences, the success rates were higher in the 1995～1997 cohort (lesion success rate: 91% vs. 80%, patients success rate 90% vs. 83%, p＜0.05). The new patient cohort tended to have less frequent serious complications (3.0% vs. 6.4%, p＜0.25), fewer Q-wave myocardial infarction (1.9% vs. 4.6%, p＜0.05), fewer combined death and Q-wave myocardial infarction (2.6% vs. 6.4%, p＜0.01). But the rate of abrupt closure after balloon angioplasty remained the same (4.5% vs. 4.6%, p=NS).

　　Conclusion: With the increase of experience and case-volume and the wide use of stents, the inhospital outcomes improved despite the greater patient acuity. However, due to still lower annual case-volume, the outcome of percutaneous coronary revascularization remains to be enhanced further.