经皮冠状动脉腔内成形术及植入支架的长期预后分析
Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting
目的 探讨经皮冠状动脉腔内成形术(PTCA)和PTCA+支架治疗对我国冠心病患者的远期疗效。方法 对自1986年12月至1998年6月期间在我院接受PTCA和PTCA+支架治疗的938例中的790例患者进行了随访,随访率84.2%。随访方式包括门诊随访和信访。随访时间为0.9-12.7年(平均3.5±2.4年)。结果 随访期中死亡4例(0.51%),非致命性急性心肌梗塞22例(2.8%),重复PTCA 98例(12.4%),行冠状动脉旁路移植术10例(1.3%)。以Kaplan-Meier 法计算术后12年的生存率为99.5% ,无心脏事件生存率1年为88.2%,12年为80.6%。Cox回归分析显示,陈旧性心肌梗死病史和是否放置支架与心脏事件呈负相关,而病变支数与心脏事件正相关。与单纯PTCA组比较, PTCA+支架组急性心肌梗死发生率和再次PTCA率均显著低于前者。结论 PTCA,特别是PTCA+支架治疗对我国冠心病患者有良好的疗效,可作为血管重建治疗的首选方法。
更多Objective To examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy. Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this hospital were followed by direct interview or letter. The rate of follow-up was 84.2% and the period of follow-up was 0.9-12.7 (3.5±2.4) years.Results During follow-up, 4 (0.5%) patients died, 22 (2.8%) had nonfatal acute myocardial infarction, 10 (1.3%) had coronary artery bypass surgery, and 98 (12.4%) had repeat PTCA. The rate of recurrent angina pectoris was 31.1%. The cardiac event-free survival rate calculated by the Kaplan-Meier method was 88.2% at 1 year and 80.6% at 12.7 years. Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events. Compared to the PTCA group, patients with PTCA+stent had significantly lower rates of total cardiac events.Conclusion The long-term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treatment for revascularization in patients with coronary heart disease.
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