当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY期刊下所有文献 > Long-term results of directional coronary atherectomy: predictors of restenosis.

Long-term results of directional coronary atherectomy: predictors of restenosis.

Abstract：

OBJECTIVES:This study was performed to obtain better understanding of the long-term clinical efficacy of directional coronary atherectomy. BACKGROUND:Although this procedure yields favorable acute results, its acceptance has been limited by the perception that late results (that is, freedom from restenosis) are no better than those of conventional angioplasty. METHODS:A total of 225 atherectomies performed in 190 patients between August 1988 and July 1991 were examined. Minimal lumen diameter of the treated segments was measured on angiograms obtained before, after and 6 months after intervention. RESULTS:Although most lesions (97%) had one or more characteristics predictive of unfavorable short- or long-term results after conventional angioplasty, atherectomy was successful in 205 lesions (91%) with a mean residual stenosis of 7 +/- 16%. After subsequent balloon angioplasty in 16 unsuccessful atherectomy attempts, procedural success was 98%. There were no deaths or Q wave myocardial infarctions, and one patient (0.5%) underwent emergency bypass surgery. Six-month angiographic follow-up was obtained in 77% of the eligible patients. The overall angiographic restenosis rate was 32%. Predictors of a lower restenosis rate included a postprocedure lumen diameter > 3 mm (24% vs. 39%, p = 0.047), serum cholesterol < or = 200 mg/dl (18% vs. 40%, p = 0.018) and recent myocardial infarction (16% vs. 37%, p = 0.034). Life-table analysis showed a 2% mortality rate and a 26% incidence of other events (myocardial infarction, repeat revascularization) within the 1st year. The annual 5% mortality rate and 7% incidence of other events during years 2 and 3 were related in large part to the existence or progression of disease at other locations. CONCLUSIONS:Six-month angiographic follow-up of patients who underwent directional coronary atherectomy during the 1st 3 years of our experience shows an overall restenosis rate of 32%, with lower rates in patients with a postatherectomy lumen diameter > or = 3 mm, cholesterol level < or = 200 mg/dl or a recent myocardial infarction. Few if any events relating to the site of atherectomy developed after the 1st year of follow-up.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Fishman RF,Kuntz RE,Carrozza JP Jr,Miller MJ,Senerchia CC,Schnitt SJ,Diver DJ,Safian RD,Baim DS

doi

10.1016/0735-1097(92)90365-t

subject

Has Abstract

pub_date

1992-11-01 00:00:00

pages

1101-10

issue

eissn

0735-1097

issn

1558-3597

pii

0735-1097(92)90365-T

journal_volume

pub_type

杂志文章

在线工具

Long-term results of directional coronary atherectomy: predictors of restenosis.