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Long-term outcome of primary percutaneous transluminal coronary angioplasty for low-risk acute myocardial infarction in patients older than 80 years: A single-center, open, randomized trial

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AMERICAN HEART JOURNAL 2002年第3期143卷 497-505页

作者： Minai, K Horie, H Takahashi, M Nozawa, M Kinoshita, M Shiga Univ Med Sci Dept Internal Med 1 Otsu Shiga 5202192 Japan

Background Although coronary reperfusion therapy with thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) immediately after acute myocardial infarction (AMI) has survival benefits for younger patients, the effect of coronary reperfusion therapy for very elderly (aged 80 years and older) patients with AMI remains controversial. Methods and Results We studied 120 patients aged 80 years and older at relatively low risk with AMI. The patients were randomized into a primary PTCA group In = 61) or a "conservative" no-PTCA group In = 59). Long-term follow-up examination was conducted with regard to endpoints, which included all causes of death, cardiac death, nonfatal re-MI, the development of congestive heart Failure, and cerebral vascular accident. End-diastolic volume index and end-systolic volume index were significantly increased in both groups at follow-up examination 6 months after AMI However, left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were similar between both groups. With endpoints of all causes of death, cardiac death, reinfarction, congestive heart failure, and cerebral vascular accident, a 3-year Kaplan-Meier event-free survival rate analysis revealed no significant benefits in the PTCA group. Anteroseptal MI, multivessel disease, and left ventricular ejection Fraction were significantly associated with the combined events with multivariate Cox proportional hazards analysis results. Conclusion First, primary PTCA for very elderly patients with AMI appears to have few beneficial effects on combined events during a 3-year period. Second, early PTCA did not prevent left ventricle remodeling after AMI in patients with AMI at relatively low risk.

关键词：血管成形术经腔经皮冠状动脉/死亡率抗凝药/治疗应用生物学标记/血液死亡原因冠状血管造影术肌酸激酶/血液随访研究肝素/治疗应用日本多元分析心肌梗死/死亡率心肌梗死/放射摄影术心肌梗死/治疗比值比复发回归分析存活率心室功能左心室重构老年人 80以上老年人女(雌)性人类男(雄)性

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Comparison of in-hospital outcomes after coronary angioplasty with or without stent placement for acute myocardial infarction

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第9期86卷 998-1000页

作者： Vakili, BA Brown, DL Montefiore Med Ctr Albert Einstein Coll Med Dept Cardiovasc Med Bronx NY 10461 USA

The primary goal of treatment for patients with acute myocardial infarction (AMI) associated with ST-segment elevation is rapid and complete reperfusion of the infarct-related artery with thrombolytic agents or mechanical therapy, such as primary percutaneous transluminal coronary angioplasty (PTCA). Randomized trials comparing thrombolytic treatment with primary PTCA have demonstrated improvements in coronary flow along with reductions in residual stenosis, reinfarction, and death when timely reperfusion was accomplished with PTCA.1–6 Subsequent trials have compared the results of primary PTCA with stent placement for patients with AMI.7–10 To date, no randomized trial has demonstrated a mortality reduction associated with stent implantation in the setting of AMI. Data regarding the impact of stenting in AMI on mortality outside the restricted setting of randomized trials remain largely confined to small series or registries from high-volume institutions with specific expertise in this area. Thus, we report on in-hospital mortality of a population of patients who underwent mechanical revascularization within 6 hours of onset of AMI in New York State in 1995.

关键词：血管成形术经腔经皮冠状动脉/方法血管成形术经腔经皮冠状动脉/死亡率置信区间医院死亡率/发展趋势 Logistic模型心肌梗死/诊断心肌梗死/死亡率心肌梗死/治疗纽约比值比预后登记支架存活率分析治疗结果成年人女(雌)性人类男(雄)性中年人

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Prediction of death after percutaneous coronary interventional procedures

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AMERICAN HEART JOURNAL 2000年第6期139卷 1032-1038页

作者： Rihal, CS Grill, DE Bell, MR Berger, PB Garratt, KN Holmes, DR Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Rochester MN 55905 USA

Background The prediction and comparison of procedural death oiler percutaneous coronary interventional procedures is inherently difficult because of variations in case mix and practice patterns. The impact of modern, expanded patient selection criteria, and newer technologic approaches is unknown. Our objective was to determine whether a risk equation bored on patient-related variables and derived from an independent data set can accurately predict procedural death after percutaneous coronary intervention in the current era. Methods and Results An analysis was made of the Mayo Clinic Coronary Interventional Database January 1, 1995, to October 31, 1997. Expected mortality rate was calculated with the use of the New York State multivariate risk score. In 3387 patients. 3830 procedures (55.1% stents) were performed, with an expected mortality rate ai 2.32% and observed mortality rate of 2.38% (P = not significant). The risk score derived from the New York multivariate model was highly predictive of death (chi-square = 213.8;P < .0001). The presence of a high-risk lesion characteristic such as calcium, thrombus, or type C lesion was modestly associated with death. Conclusions The New York State multivariate model accurately predicted procedural death in our database.

关键词：心绞痛不稳定型/死亡率心绞痛不稳定型/放射摄影术心绞痛不稳定型/治疗血管成形术经腔经皮冠状动脉/死亡率冠状血管造影术医院死亡率医院记录/统计学和数值数据心肌梗死/死亡率心肌梗死/放射摄影术心肌梗死/治疗纽约/流行病学预后前瞻性研究可重复性结果危险性评估性别分布存活率女(雌)性人类男(雄)性中年人

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Comparison of immediate and in-hospital results of conventional balloon and perfusion balloon angioplasty using intracoronary ultrasound

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期83卷 311-316页

作者： Timmis, SBH Hermiller, JB Burns, WH Meyers, SN Davidson, CJ Northwestern Mem Hosp Chicago IL 60611 USA St Vincents Med Ctr Indianapolis IN USA

Angiographic studies have demonstrated that perfusion balloon percutaneous transluminal coronary angioplasty (PTCA) may result in modestly improved luminal gains and fewer major dissections than conventional balloon PTCA. However, intracoronary ultrasound (ICUS), which is more sensitive than angiography in evaluating the incidence, extent, and severity of dissection, was not used. We randomized 48 patients with 54 coronary stenoses to conventional or perfusion balloon PTCA. Four 2-minute inflations were permitted with conventional balloon PTCA. Two 10-minute inflations were allowed with perfusion balloon PTCA. Quantitative coronary angiography and ICUS were performed before and after treatment. In-hospital clinical events were recorded. Conventional and perfusion balloon PTCA achieved similar improvements in lumen diameter (1.25 +/- 0.51 vs 1.28 +/- 0.51 mm) and reductions in percent stenosis (-45 +/- 21% vs -44 +/- 15%) by quantitative coronary angiography. Comparable gains in lumen diameter (0.62 +/- 0.39 vs 0.50 +/- 0.38 mm) and lumen area (2.70 +/- 1.96 vs 2.05 +/- 1.52 mm(2)) were observed on ICUS. Angiography demonstrated similar rates of any dissection (36% vs 21%) and major dissection (12% vs 7%). ICUS identified a similar incidence of any dissection (60% vs 76%) and type II dissection (52% vs 62%). The relative dissection area was also similar (9.2 +/- 5.6% vs 7.8 +/- 5.8%). One conventional balloon patient experienced postprocedural chest pain. No patient in either group died, or had myocardial infarction, abrupt closure, or urgent revascularization. (C)1999 by Excerpta Medico, Inc.

关键词：血管成形术经腔经皮冠状动脉/死亡率冠状血管造影术冠心病/死亡率冠心病/放射摄影术冠心病/治疗冠心病/超声检查交叉研究随访研究医院死亡率前瞻性研究复发敏感性与特异性治疗结果超声检查介入性/死亡率女(雌)性人类男(雄)性中年人

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Comparison of artificial neural networks with logistic regression in prediction of in-hospital death after percutaneous transluminal coronary angioplasty

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AMERICAN HEART JOURNAL 2000年第3期140卷 511-520页

作者： Freeman, RV Eagle, KA Bates, ER Werns, SW Kline-Rogers, E Karavite, D Moscucci, M Univ Michigan Med Ctr Heart Care Program Ann Arbor MI 48109 USA

Objectives Our objective was to compare artificial neural networks (ANNs) with logistic regression for prediction of in-hospital death after percutaneous transluminal coronary angioplasty and to assess the impact of guiding initial ANN variable selection with univariate analysis. Background ANNs can detect complex patterns within data. Criticisms include the unpredictability of variable selection. They have not previously been applied to outcomes modeling For percutaneous coronary interventions. Methods A database of consecutive (n = 3019) percutaneous transluminal coronary angioplasty procedures from an academic tertiary referral center between July 1994 and July 1997 was used. An ANN was developed for 38 variables (unguided model) (n = 1554). A second model was developed with predictors from an univariate analysis (guided model). Both were compared with a logistic regression model developed from the same database. Model validation was performed on independent data (n = 1465). Model predictive accuracy was assessed by the area under receiver operating characteristic curves. Goodness of fit was assessed with the Hosmer-Lemeshow statistic. Results Sixty unguided and guided ANNs were developed. Predictive accuracy and model calibration for all models were similar for training data but were significantly better for logistic regression for independent validation data. Overestimation of event rate in higher risk patients accounted for the majority of discrepancy in model calibration for the ANNs. This difference was partially amended by guiding variable selection. Conclusion ANNs were able to model in-hospital death after percutaneous transluminal coronary angioplasty when guiding variable selection. However, performance was not better than traditional modeling techniques. Further investigations are needed to understand the impact of this methodology on outcomes analysis.

关键词：血管成形术经腔经皮冠状动脉/死亡率数据库事实型 Logistic模型神经网络(计算机) 试验预期值预后危险性评估老年人女(雌)性人类男(雄)性中年人

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Ten-year outcome after coronary angioplasty in patients with single vessel coronary artery disease and comparison with the results of the coronary artery surgery study (CASS)

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3期85卷 321-326页

作者： Espinola-Klein, C Rupprecht, HJ Erbel, R Nafe, B Brennecke, R Meyer, J Johannes Gutenberg Univ Mainz Med Clin 2 D-55101 Mainz Germany Johannes Gutenberg Univ Mainz Inst Stat & Informat D-55101 Mainz Germany Univ Essen Gesamthsch Dept Cardiol Essen Germany

The 10-year results of randomized trials comparing percutaneous transluminal coronary angioplasty (PTCA) in patients with single-vessel coronary artery disease (CAD) with coronary artery bypass grafting (CABG) and medical treatment are not available yet. The aim of this evaluation was to compare our 10-year follow-up results after PTCA in patients with single-vessel CAD with the 10-year follow-up results after CABG and medical treatment in the Coronary Artery Surgery Study (CASS) trial. We evaluated the clinical outcome of 509 patients with single-vessel CAD 10 years after coronary angioplasty, The data were compared with the results of 214 patients with single-vessel CAD after CABG or medical treatment from the CASS trial. End points were defined as death and myocardial infarction. Statistical evaluation was performed by life-table analysis and 2-sided Fisher's exact test. The rate of survival was 86% 10 years after PTCA compared with 85% after CABG and 82% after medical treatment in patients from the CASS trial (p = NS). Survival free from myocardial infarction was 77% after coronary angioplasty, 70% after CABG, and 72% after medical treatment (p = NS), Thus, in patients with single-vessel CAD, infarct-free survival 10 years after coronary angioplasty compared favorably with the results after bypass surgery or medical treatment from the CASS trial. (C)2000 by Excerpta Medica, Inc.

关键词：肾上腺素能β受体拮抗剂/治疗应用血管成形术经腔经皮冠状动脉/死亡率抗凝药/治疗应用降血脂药/治疗应用钙通道阻滞药/治疗应用冠状动脉分流术/死亡率冠心病/药物疗法冠心病/治疗无病生存随访研究德国/流行病学硝酸甘油/治疗应用问卷调查存活率分析治疗结果女(雌)性人类男(雄)性中年人

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Percutaneous intervention in the very elderly: Weighing the risks and benefits

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AMERICAN HEART JOURNAL 1999年第4期137卷 585-587页

作者： Peterson, ED Batchelor, WB Duke Univ Med Ctr Outcomes & Res Assessment GrpDuke Clin Res Inst Div CardiolDept Med Durham NC 27710 USA

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Why is mortality rate after percutaneous transluminal coronary angioplasty higher in women?

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AMERICAN HEART JOURNAL 1999年第4期137卷 582-584页

作者： Brodie, BR Moses Cone Mem Hosp Greensboro NC USA LeBauer Cardiovasc Res Fdn Greensboro NC USA

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Coronary angioplasty after the age of 80 - why not dust where the dust is?

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EUROPEAN HEART JOURNAL 1999年第24期20卷 1771-1772页

作者： Meier, B Univ Hosp Bern CH-3010 Bern Switzerland

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Percutaneous Balloon Coarctation Angioplasty: Long‐Term Results

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Journal of Interventional Cardiology 1992年第1期5卷 57-62页

作者： LABABIDI, ZUHDI University of Missouri-Columbia Columbia Missouri United States

One hundred and ten patients, age 2 days to 35 years (mean 7.0 ± 7.0 years), have undergone 118 percutaneous balloon angioplasty procedures for discrete coarctation of the aorta since April 1982. The mean systolic gradient was significantly decreased from 48 ± 22 to 8 ± 7 mmHg after angioplasty (P < 0.0001). Long‐term results were evaluated in 95 patients, by follow‐up catheterization in 30 and Doppler echocardiography in 65 patients. The follow‐up period was 1–9 years (4.2 ± 2.1). At follow‐up the mean residual gradient was 9 ± 8 mmHg. On the basis of follow‐up data, four groups of patients were identified:group I consisted of 53 patients over 3 months of age with native coarctation of the aorta;group II consisted of 13 patients with postoperative coarctation restenosis;group III consisted of 21 infants 3 months of age or younger with native coarctation of the aorta;and group IV consisted of eight infants who developed postdilatation restenosis. Patients in groups I and II had good results and required no redilatation or surgical repair. In group III successful redilatation in eight and surgical repair in seven infants were performed 1 month to 5 years after the initial dilatation. There were no mortalities related to the 118 dilatation procedures. Of the seven patients who had surgical repair of the coarctation and the associated cardiac anomalies, four expired in the immediate postoperative period. Percutaneous balloon coarctation angioplasty is an effective definitive treatment for native as well as postoperative aortic coarctation in patients over the age of 3 months. Infants with coarctation of the aorta associated with other cardiac anomalies may require repeat dilatation or surgical repair. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：血管成形术经腔经皮冠状动脉/方法血管成形术经腔经皮冠状动脉/死亡率主动脉缩窄/治疗主动脉缩窄/超声检查超声心动描记术多普勒评价研究随访研究复发青少年成年人儿童儿童学龄前人类婴儿婴儿新生

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