王智,唐强,刘坤,曲华清,颜东,陈学智,唐群中,史震涛,刘秀敏

• 1:北京大学首钢医院心内科

摘要(Abstract)：

目的研究冠心病多支血管病变(multivessel coronary artery disease,MVD)部分血运重建后优化药物治疗(optimizing drug therapy,OMT)对非干预血管病变的临床意义。方法对于256例冠心病多支血管病变患者进行部分血运重建(incomplete coronary revascularization,IR)+标准优化药物治疗1年后通过定量冠状动脉造影分析(quantitative coronary angiography,QCA),对未干预血管病变最小血管直径(the minimal luminal diameter,MLD)及血管直径狭窄率进行对比。结果 256例部分血运重建患者非干预血管病变QCA结果显示,临床指标达标患者190例,其中182例(95.8%)患者未干预血管病变MLD及直径狭窄率较前减轻或无变化,8例(4.2%)患者未干预血管病变MLD及直径狭窄率较前加重。临床指标未达标患者66例,其中56例(84.8%)患者未干预血管病变MLD及直径狭窄率较前减轻或无变化,10例(15.2%)患者未干预血管病变MLD及直径狭窄率较前加重。临床指标达标患者总有效性明显高于未达标患者(95.8%对84.8%,χ2=7.375,P<0.05),总无效性明显低于未达标患者(4.2%比15.2%,χ2=7.375,P<0.05)。结论冠心病多支血管病变部分血运重建患者优化药物治疗对于未干预血管病变具有明显临床意义。

关键词(KeyWords)： 冠心病;心肌血管重建术;药物疗法;冠状血管造影术

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王智,唐强,刘坤,曲华清,颜东,陈学智,唐群中,史震涛,刘秀敏

参考文献(References)：

• [1]The BARI investigators.Influence of diabetes on5-year mortalityand morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease:the Bypass Angioplasty Revascularization Investigation(BARI).Circulation,1997,96:1761-1769.
• [2]Jeremias A,Kaul S,Rosengart TK,et al.The impact of revascularization on mortality in patients with nonacute coronary artery disease.Am J Med,2009,122:152-161.
• [3]Katritsis DG,Ioannidis JP.Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease:a meta-analysis.Circulation,2005,111:2906-2912.
• [4]Schmig A,Mehilli J,De Waha A,et al.A meta-analysis of17randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease.J Am Coll Cardiol,2008,52:894-904.
• [5]Trikalinos TA,Alsheikh-Ali AA,Tatsioni A,et al.Percutaneous coronary interventions for non-acute coronary artery disease:a quantitative20-year synopsis and a network meta-analysis.Lancet,2009,373:911-918.
• [6]Boden WE,O'Rourke RA,Teo KK,et al.Optimal medical therapy with or without PCI for stable coronary disease.N Engl J Med,2007,356:1503-1516.
• [7]Dagenais GR,Lu J,Faxon DP,et al.Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularizations in patients with type2diabetes mellitus and stable ischemic heart disease.Circulation,2011,123:1492-1500.
• [8]Kim YH,Park DW,Lee JY,et al.Impact of angiographic complete revascularization after drug-eluting stent implantation or coronary artery bypass graft surgery for multivessel coronary artery disease.Circulation,2011,123:2373-2381.
• [9]Tonino PA,De Bruyne B,Pijls NH,et al.Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.N Engl J Med,2009,360:213-224.