直接冠状动脉支架置入术的前瞻性临床研究  

Prospective clinical study on direct coronary stenting

作　　者：韩雅玲[1] 荆全民[1] 王守力[1] 王冬梅[1] 苗志林[1] 王祖禄[1] 刘海伟[1] 张晓星[1] 

机构地区：[1]沈阳军区总医院全军心血管内外科研究所心内科,110016

出　　处：《中华心血管病杂志》2002年第5期265-268,共4页Chinese Journal of Cardiology

摘　　要：目的　前瞻性探讨无预扩张直接冠状动脉支架置入术的即刻和长期效果。方法　 1 997年 5月～ 2 0 0 0年 1 2月共 4 6 5例冠心病患者入选该研究 ,选择性冠状动脉造影示 4 6 5处靶病变狭窄程度 6 0 %～ 99%,平均 (79± 1 0 8) %,均为单支、单处病变 ,随机分至无预扩直接支架组 (A组 )、预扩后置入支架组 (B组 )及单行经皮冠状动脉腔内成形术 (PTCA)组 (C组 )。结果　A组与B组支架置入成功率差异无显著性。PTCA组术后即刻残余狭窄明显大于两个支架组 (P <0 0 1 )。A组X线暴光时间、手术时间、造影剂及球囊导管用量均明显少于其他两组。术后所有患者心绞痛消失。随访 8～ 5 1(2 7 9± 1 5 9)个月 ,A、B、C组心绞痛复发率分别为 4 3 %、1 8 6 %及 2 9 5 %(P <0 0 5 ) ;共有 1 87例患者复查冠状动脉造影 ,示A、B、C组再狭窄率分别为 8 6 %、1 3 3 %及 2 8 6 %,无症状存活率分别为95 2 %、80 3 %及 6 8 2 %(P <0 0 1 )。结论　对选择恰当的冠状动脉病变 ,直接冠状动脉支架置入术具有较高的即刻成功率。Objective To explore the immediate and long term outcomes of direct coronary stenting without predilatation Methods From May 1997 to December 2000, 465 patients were enrolled into this study The selective coronary angiogram(SCA) showed a mean target lesion stenosis of (79±10 8)%(ranged from 60% to 99%) All patients had single vessel disease with single lesion They were randomized into 3 groups:direct stenting without predilatation (group A), stenting with predilatation (group B), and balloon angioplasty(PTCA) only (group C) Results There was no significant difference in implantation between groups A and B In group C, the residual stenosis after intervention was significantly higher than that in groups A and B ( P <0 01) The times of X ray exposure and procedure, the amount of contrast consumed, and the number of catheter used were significantly less in group A than in other two groups Angina pectoris (AP) after intervention disappeared in all three groups All patients underwent 8 to 51(27 9±15 9)months follow up The recurrence rates of AP in the three groups were 4 3%, 18 6% and 29 5%, respectively ( P <0 05) The restenosis rates in 187 patients who had undergone SCA during follow up were 8 6%, 13 3% and 28 6%, respectively Symptom free survival rates of the patients were 95 2%,80 3% and 68 2%, respectively ( P <0 01) Conclusion For the properly selected lesions, direct coronary stenting is safe and has a high immediate success rate and an ideal long term outcome

关 键 词：直接冠状动脉支架置入术 冠状动脉疾病 临床试验 前瞻性研究 冠心病 

分 类 号：R541.405[医药卫生—心血管疾病]