多支冠状动脉病变完全及不完全介入性血运重建1年疗效的比较

Comparison of one-year outcome between complete and incomplete interventional revascularization in patients with multivessel coronary disease

目的比较多支冠状动脉病变患者经皮冠状动脉介入术(PCI)进行完全性和不完全性血运重建术后1年的临床疗效。方法分析1995年6月～2004年9月接受PCI的2579例冠心病患者,其中完全性血运重建组2278例(88.3%),不完全性血运重建组301例,对比分析两组PCI术后1年的随访结果。结果不完全性血运重建组患者中3支血管病变、复杂B2/C型病变、完全闭塞病变的比例均高于完全性血运重建组(P<0.01),术前靶血管狭窄程度亦较后者严重(P<0.05);完全血运重建组PCI成功率明显高于不完全血运重建组(96.4%vs94.0%,P<0.05)。对2426例患者进行了12个月的随访,总随访率为94.1%。两组造影复查率、造影复查再狭窄率无显著差异(56.4%vs55.3%,15.2%vs19.2%,P均>0.05)。完全性血运重建组患者心绞痛复发率和主要不良心脏事件发生率均显著低于不完全性血运重建组(5.7%vs9.2%,P<0.05;21.2%vs31.6%,P<0.01)。结论多支冠状动脉病变行介入完全性血运重建的患者1年长期临床疗效优于不完全性血运重建者。

Objective To compare the one-year outcome between complete and incomplete revascularization by percutaneous coronary intervention （PCI） in patients with muhivessel coronary disease. Methods From June 1995 to September 2004, a total of 2579 patients with muhivessel coronary disease were treated by PCI in our centre, among them 2278 patients （88. 3 % ） achieved complete revascularization （CR group） and 301 patients achieved incomplete revascularization （IR group）. （Me-year outcome was compared between the two groups. Results The rates of triple vessel disease, complex type B2/C lesions, chronic total occlusion were significantly higher in IR group than those in CR group, and the target vessel stenostic degree before PCI was also more severe in IR group. The PCI success rates in CR group and IR group were 96. 4% and 94. 0% （P〈0. 05）, respectively. The follow-up duration for 2426 patients was 12 months and the clinical follow-up rate was 94.1% （2426/2579）, and among them the rates of angiographie follow-up and angiographie restenosis were similar in the two groups （56. 4 % vs 55.3 %, 15.2 % vs 19.2 %, P〈0. 05）. The rates of angina recurrence and maior adverse cardiac events （MACE） were significantly lower in CR group patients compared with the patients in IR group （5.7% vs 9.2%, P〈0. 05; 21.2% vs 31.6%, P〈0. 01, respectively）. Conciusion Complete revascularization by PCI in patients with muhivessel coronary disease can achieve better one-year clinical outcome compared with incomplete interventional revascularization.