冠状动脉临界病变介入与药物治疗的预后比较

Percutaneous coronary intervention and drug treatment of critical coronary artery disease: a comparison of prognoses

目的比较冠状动脉临界病变行冠状动脉介入治疗（PCI）与药物治疗的预后。方法选择上海中医药大学附属普陀区中心医院心内科2010年1—12月经冠状动脉造影检查证实为冠状动脉临界病变的患者79例,男44例,女35例。采用血管内超声（IVUS）定量测量,最小管腔面积（MLA）〈4 mm2（非主干病变）或斑块负荷≥60%的患者接受PCI及常规药物治疗（介入组,42例）,MLA≥4 mm2（非主干病变）或斑块负荷〈60%的患者只接受药物治疗（药物组,37例）。比较两组住院及随访期间主要不良心脏事件（MACE）的发生情况,包括不稳定性心绞痛、心肌梗死、心力衰竭、缺血性靶血管血运重建、死亡。结果所有患者随访6~12个月,平均随访时间为（8.1±2.4）个月。随访期间,介入组心绞痛发生率、再次行PCI率均为7.1%（3/42）,与药物组（均为5.4%,2/37）的差异无统计学意义（P值均=1）。结论对于冠状动脉临界病变,在合适的技术指导下,合理地选择PCI和药物治疗,均可使患者受益。

Objective To compare the prognoses of patients with critical coronary artery diseases after percutaneous coronary intervention（PCI） and drug treatment.Methods A total of 79 patients with critical coronary artery diseases,who were treated in our hospital from January 2010 to December 2010,were selected in the present study.The patients included 44 males and 35 females.According to intravascular ultrasound（IVUS,intravascular ultrasound evaluation） evaluation of the minimum lumen area（MLA） or plaque burden,the patients were divided into coronary intervention group（receiving PCI and routine drug treatment） and drug treatment group（receiving drug treatment only）.The major adverse cardiac events（MACE）,including unstable angina,myocardial infarction,heart failure,ischemic target vessel revascularization,and death were compared between the two groups during hospitalization and follow-up.Results All the patients were followed up for 6-12 months,with a mean of（8.1±2.4） months.During follow-up period,the incidence of angina and rate of re-PCI were both 7.1%（3/42）,which was similar to those in the drug treatment group（5.4%,2/37）.Conclusion For patients with coronary artery disease,PCI plus drug treatment can also benefit patients when proper technique support is available.