摘要
目的
评价冠状动脉完全血运重建及不完全性血运重建介入和药物治疗对冠状动脉多支病变(Multivessel coronary disease MCD)患者的治疗效果,分析MCD患者预后的独立影响因素,为减少MACCE事件发生,获得更好的临床疗效提供证据。
方法
2008年6月至2009年9月在我院心内科住院,160位冠状动脉造影示多支冠脉病变患者且随访成功者,根据患者意愿和冠脉病变分为冠状动脉介入完全性血运重建组(治疗组A,n=66)、冠状动脉介入不完全性血运重建组(治疗组B,n=47)和内科常规药物治疗组(以下简称药物组,n=47),比较三组患者临床资料,随访6个月,观察终点为死亡发生和MACCE发生,观察三组患者在治疗6个月期间MACCE事件发生情况,6个月后心脏彩超射血分数。采用多因素logistic回归模型对左室EF的变化进行多因素分析。
结果
三组患者的性别构成、高血压、高脂血症、糖尿病、吸烟史及其入院时冠脉狭窄支数、心脏彩超射血分数差异无显著性意义；6个月后冠状动脉介入完全性血运重建组、冠状动脉介入不完全性血运重建组LVEF的增加优于药物组,冠状动脉介入完全性血运重建组、冠状动脉介入不完全性血运重建组之间LVEF变化无显著性意义；三组间MACCE发生率有显著性差异,两两比较示：只有完全性血运重建组与药物保守治疗组有显著性差异(13.6% vs 38.3% P=0.003),不完全性血运重建组与药物治疗组之间差异无显著性(P=0.073),完全性血运重建组及不完全性血运重建组间差异无显著性(P=0.287)。多因素Logistic回归分析示：男性、高血压、高血脂、吸烟史均与LVEF的改善负相关。
结论
(1)本研究提示冠状动脉介入完全性血运重建治疗对冠状动脉多支病变,可以显著地改善患者的心功能,降低MACCE的发生；冠状动脉介入不完全性血运重建和完全血运重建治疗均可以显著地改善患者的近期心功能。
(2)本研究提示男性、高血压、高血脂、吸烟史均是MCD患者心功能改善不佳的影响因素。
Objiective:This research is to retrospectively investigate the therapeutic effect of complete or incomplete revascularization or drug therapy in patients with multivessel coronary artery disease (MVD), As well as to identify the independent predictive factors of MCD patients in developing MACCE affecting the outcome. M ETHODS:From June 2008 to September 2009,160 patients with MVD treated in the inpatient department of cardiology were reviewed.According to treatment methods,160 patients were classified into complete revascularization group (n= 60),incomplete revascularization group (n=47) and the conservative group (n=47). The general conditions of the patients in three groups were collected and compared. Ejection factor (EF) of left ventricle were observed.The Primary end-Point was the happening of all cause death, the combined end-point was MACCE, including all cause death, recurrent infarction and the target vessel revascularization.Multivarite analysis was carried out using the Multiple logistic proportional hazards model to determine the variable relevant to the EF of left ventricle(LVEF). Results:There were no differences in sex,age, hypertension, hyperlipidemia, diabetes mellitus,smokers, NYHA, collareral circulations,the number of coronary stents and LVEF among three groups (P>0.05). After 6 months,the improvement of LVEF was remarkable higher in complete revascularization group and in incomplete revascularization group than in the conservative group(P= 0.000,P=0.000).There was not remarkable difference in the improvement of LVEF between complete revascularization group and incomplete revascularization group.The ratio of MACCE was found to be signifieantly different among three groups(P=0.009).The ratio of MACCE was remarkable higher in conversation group than in complete revascularization group (P=0.003), The ratio of MACCE was not remarkable different in incomplete revascularization group than in conversation group (P= 0.073).There was no remarkable diffenece between in complete revascularization group and in incomplete revascularization group(P=0.287). Multiple linear regression showed that hypertension,hyperlipidemia,man and smoke history were the negative dependend factors of LVEF.Conclusions:(1) complete revascularization treatment and incomplete revascularization treatment could remarkabley improve the patients' LVEF.And in complete revascularization treatment could decrease the MACCE ration than in incomplete revascularization treatment and in conversation treatment in treating MVD patients.(2) hypertension,hyperlipidemia,man and smoke history were the worsen factor of MVD patients.
引文
[1]Roberto A.Corpus,MD,John A.House,MS.Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction.Am Heart,2004,148:493-500.
[2]Zbigniew Kalarus,MD,Radoslaw Lenarczyk,MD.Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention.Am Heart,2007,153:304-312.
[3]Depre C,Wijns W,Rober AM,et al.Pathology of unstable p laque:correlation with the clinical severity of acute coronary syndromes. J Am Coll Cardiol,1997,30(3):694-702.
[4]Osswald BR, Tochtermann U, Schweiger P, et al. Does the completeness of revascularization contribute to an improved early survival in patients up to 70 years of age? Thorac Cardiovasc Surg,2001,49:373-377.
[5]The TIM I ⅢB Investigators Effects of tissue plasm inogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction:results of the TIM I ⅢB trial [J]. Circulation 1994,89:1545-1556.
[6]Boden WE,O Rourke RA, Crawford MH, et al. Veterans Affairs Non-Q-Wave Infarction Strategies in Hosp ital (VANQW ISH) Trial Investigators. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy[J]. N Engl JMed,1998,338:1785-1792
[7]Ragmin F, Fast Revascularisation during InStability in Coronary artery disease Investigators. Invasive compared with non-invase treatment in unstable coronary artery disease:FR ISC II p rospective randomisedmulticentre study[J]. Lancet,1999,354:708-715.
[8]Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (W riting Committee to Revise the 2002 Guidelines for the Management of PatientsW ith Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic EmergencyMedicine [J]. J Am Coll Cardiol,2007,50:129-157.
[9]Berger PB, Holmes DR J r, Ohman EM, et al. Restenosis, reocclusion and adverse cardiovascular events after successful balloon angiop lasty of occluded versus nonoccluded coronary arteries. Results from the multicentre American research trialwith cilazap ril after angiop lasty to p revent tnmsluminal coronary obstruction and restenosis(MARCATOR) [J]. J Am Coil Cardiol,1996,27:110-119.
[10]Ivanhoe RJ,Weintraub WS,Douglas JS, et al. Percutaneous transluminal coronary angiop lasty of chronic total occlusions. Primary success, restenosis, and longterm clinical follow-up [J]. Circulation,1992,85:106-115.
[11]Han YL,Wang SL, J ingQM, et al. Percutaneous coronary intervention for chronic total occlusion in 1 263 patients:a single-center report [J]. Chin Med J (Engl),2006,119: 1165-1170.
[12]Weisz G, Moses JW. New percutaneous app roaches for chronic total occlusion of coronary arteries[J]. Expert Rev Cardiovasc Ther,2007,5 (2) : 231-241.
[13]INDOL FI C, PAVIA M, ANGEL ILLO IF. Drug-E-luting stents versus bare metal stent s in percutaneous coronary interventions (A meta-analysis) [J]. Am J Cardiol,2005,95:1146-1152.
[14]高迎春,马长生,聂绍平,et al.冠心病多支病变雷帕霉素洗脱支架置入与冠状动脉旁路移植术的疗效对比[J].临床心血管病杂志,2008,24(2)：91-94
[15]Serruys PW. Comparison of coronary artery bypass Surgery and stenting for the treatment of multivessel disease. N Engl J Med,2001,344:1117
[16]Rodriguez A, Bernardio V, Navia J, et al. Argentine randomized study:Coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI Ⅱ):30-day and one-year follow up results. J Am Coll Cardiol,2001,37:51-62
[17]Hannan EL, Racz MJ, Walford G.. Long-term outcomes of coronary-artery bypass grafting versus stent implantation; N Engl J Med,2005,21:74-80
[18]Favarato ME, Hueb W, Boden WE. Quality of life in patients with symptomatic multivessel coronary artery disease:a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS Ⅱ trial; Int J Cardiol,2007,364-370.
[19]Ferguson TB Jr, Hammill BG, Peterson ED. A decade of change-risk profiles and outcomes for isolated coronary artery bypass grafting procedures,1990-1999:a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons; Ann Thorac Surg,2002,480-489.
[20]Colonna P, Iliceto S. Myocardial infarction and left ventricular remodeling:results of the CED M trial. CarnitineEcocardiografia Digitalizzata Infarto Miocardico [J]. Am Heart J, 2000,139:124-130.
[21]Mari C, Straus W.Detection and characterization of hibernation myocardium.Nucl Med Commun.2002,23:311-322.
[22]schelbertHR.18F-Deoxyglueose and the assessment of myoeardial viabiliyt.Seminarsin Nuelear Medieine,2002; 11(1):60-69
[23]Lueiginani G, Landoni C, Paolini G, et al.Positron emmission tomography for The assessment of myocardial viability:a synopsis of methods and indications.Rays.1999, 24:81-95.
[24]Di Sciascio G,Patti G,D Ambrosio A,et al.Coronary stenting in patients with depressed left wentricular function:acute and long-term results in a selected population.Catheter Cardiovasc Interv,2003,59(4):429.
[25]陈国伟.心肌病的介入治疗.中国实用内科杂志,2004,24(1)：9-10.
[26]Pagano D,Fath Ordoubadi F,Beatt K,et al.Effects of coronary revascularization on myocardial blood flow and coronary vasodilator reserve in hibernating myocardium.Heart,2001,85(2):208.
[27]Werner GS, Surber R, Kuethe F, et al. Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion[J]. Am Heart J,2005,149:129-137.
[28]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志,2007,35(12)：1076-1095.
[29]杨新春,那开宪,陈瑾主编.心力衰竭临床与实践(M).北京：人民卫生出版社,2008,58-59,78-113,133-135
[30]EuroPean society of Cardiology.Esc Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. EuroPean Heart Journal,2008,29:2388-2442.
[1]Kyriakides z S, Tottsoulis D, Iliodromitis E K, et al. The reactivity of the eontralateral artery at the time of balloondingtion during coronary angioplasty[J]. Eur Heart J,1995,16:794-798
[2]Rentrop KP, Thornton JC, Feit F, et al. Determinants and p rotective potential of coronary arterial collaterals as assessed by an angioplasty model[J]. Am J Cardiol,1988,61 (10): 677-684
[3]Camerliugo M, Casto L, Censori B, et al. Anticardiolopin antibodies in acute nonhemorrhagic stroke seen with in six hours after onset. Acta Newrol Scand,1995,92(1): 69
[4]李占全主编.冠状动脉造影与临床.沈阳：辽宁科学技术出版社,2001.114-125
[5]Volta SD, Corbara F. The collateral circulation in ischemic heart disease. Medicographia, 1988,10:33-40
[6]郭静萱,李易,郭丽君,等.冠脉侧支循环及其临床意义.中国介入心脏病学杂志,1999,7(1)：1-3
[7]Volta SD, Corbara F. The collateral circulation in ischemic heart disease. Medicographia, 1988,10:33-40
[8]Saito Y Importance of coronary collaterals for restoration of left ventricular function after intracoronary thrombolysis. Am J cardiol,1985,55:1259
[9]Rentrop P. Changes in infusion in clinically evolving myocardial infarction. Am Heart, 1981,102:1188
[10]徐广马,林英忠,王风.冠心病患者侧支循环与冠状动脉病变的关系.广西医学,1999,21(2)：195-197
[11]Mason MJ, Walker SK, Patel DJ,et al. Influence of clinical and angiographic factors on development of collateral channels.Coron Artery Dis,2000,11(8):573-578
[12]Piek JJ, van Liebergen RAM, Koch KT, et al. Chinical,angiographic and hemodynamic predictors of recuitable collateral flow assessed during balloon angioplasty occlusion. J Am Coll Cardiol,1997,29:275-282
[13]Senti S, Fleisch M, Billinger M, et al. Long-term physical exercise and quantitavely assessed human coronary collatery circulation. J Am Coll Cardiol,1998,32(1):49-56
[14]Perez-Castellano N, Garcia EJ, Abeytua M, et al. Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction. J Am Coll Cardiol 1998,31(3): 512-518。
[15]Antoniucci D, Valenti R, Moschi G. et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic ontcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol,2002,89(2): 121-125
[16]Nathoe HM,Koerselman J,Buskens E,et al. Determinants and prognostic significance of collaterals in patientsundergoing coronary revascularization[J]. Am J Cardiol,2006. 98(1):31-35
[17]Habib GB, Heibig J, Forman SA, et al. Influence of coronary collateral vessels on myocardial infarct size in humans:results of phase I Thrombolysis In Myocardial Infarction (TIMI) trial:the TIMI investigators. Circulation,1991,83:739-746
[18]Hirai T, Fujita M, Nakajima H, et al. Importance of collateral circulation for prevention of left ventricular aneurysm formation in acute myocardial infarction. Circulation 1989, 79:791-796
[19]Kodama K, Kusuoka H, Sakai A, et al. Collateral channels that develop after an acute myocardial infarction prevent subsequent left ventricular dilation. J Am Coll Cardiol 1996, 27(5):1133-1139
[20]何建彤.冠状动脉完全闭塞病变1145例回顾性分析[J].现代医药卫生,2005,21(8)：943.
[21]Kilian JG, keech A, Adams MR, et al. Coronary collateralization:determinants of adequate distal vessel filling after arterial occlusion. Coron Artery Dis,2002,13(3):155-159
[22]Van Belle E, Rivard A, Chen D, et al. Hypercholesterolemia attenuates angiogenesis but does not preclude augmentation angiogenic cytokines. Circulation,1997,96:2667-2674
[23]Pohl T, Seilar C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease. Am Coll Cardiol,2001,38(7):1872-1878
[24]Islam M M. Ali A,Khan NA, et al. Comparative study of coronary collaterals in diabetic and nondiabetic patients by angiography [J]. Mymensingh Med.2006.15(2):170-175
[25]W eihrauch D. Lohr NI, M raovic B, et a 1. Chronic Hypergtycem ia Attenuates Coronary Collateral Developmentand Impairs Proliferative Properties of Myocardial Interstitial Fluid by Production of Angiostatin[J]. Circulation,2004,1((19):2343-2348
[26]MelidonisA, Tonrnis S; KonvarasG, et al. comparion Of corenmy colateral circulation in diabetic and nondiabetic patients sufering from corenmy artery disease[J]. Clin Cardiol, 1999,22(7):465
[27]Wolfgang Schaper, Ivo Buschmann. Collateral circulation and diabetes[J]. Circulation, 1999,99(17):2224
[28]Koerselman J, de Jaegere PP. Verhaar MC. et al. High blood pressure is inversely related with presence and extent of coronary collaterals [J]. J Hum Hypertens,2005,19(1):809-817
[29]Kyriakides ZS, Kremastinos DT. M ichelakakis NA. et al. Coronary collateral circulation in coronary artery disease and systemic hypertension[J]. Am J Cardiol,1991,67(8):687-90
[30]Sezer M. Ozcan M, Okcular I, et al. A potential evidence to explain the reason behind the devastating prognosis of coronary artery disease in uraemic patients:renal insufficiency is associated with poor coronary collateral vessel development[J]. Int J Cardiol, 2007, 115(3):366-372
[31]葛雷.葛均波,钱菊英,等.吸烟对冠状动脉侧支血管形成影响的临床研究[J].上海医学,2003,26(9)：628-631
[32]贾志梅,齐国先,曾定尹,等.闭塞性冠状动脉病变侧支循环形成的影响因素及其临床意义.中国循环杂志,2002,17(1)：23-24
[33]Koerselman j, de Jaegere PP, Verhaar MC, at al. Coronary collateral circulation:the effects of smoking and alcohol[J]. AtherOsclerOsis,2007,191(1):191-198
[34]Ilia R, Carmel S, Gueron M. Patients with coronary Collaterals and normal left ventricular systolic function:clinical, hemodynamic, and angiographic characteristics. Angiology, 1998,49(8):631-635
[35]Antoniucci D, Valenti R, Moschi G et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic ontcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol,2002,89(2): 121-125
[36]Abaci A, Oguzhan A, Kahraman S, et al. Effect of diabetes mellitus on formation of coronary collateral vessels. Ciroulation,1999,99:2239-2242
[37]Nakae 1, Fujita M, Miwa K, et al. Age-dependent impairment of coronary collateral development in humans. Heart Vessels,2000,15(4):176-180
[38]Billinger M, Kloos P, Eberli FR, et al. Physiologically assessed coronary collateral flow and adverse cardiac ischemic events:a follow-up study in 403 patients with coronary artery disease. J Am Coll Cardiol,2002,40(9):1545-1550
[39]Patel SR,Breall JA, Diver DJ, et al. Bradycardia is associated with development of coronary collateral vessels in humans.Coron Artery Dis,2000,11(6):467-472
[40]Banai S, Jalditsh M T, Shou M, et al. Circulation,1994,89:2183
[41]Henry TD. Rocha Singh K. Isner JM. et al. Intracoronary administration of recombinant human vascular endohelial growth factor to patients with coronary artery disease[J]. Am Heart J.2001.142(5):872-880
[42]张曼,郭启煌,张福春,等.血管内皮生长因子对兔左冠状动脉前降支结扎心肌侧支循环建立影响.中国危重病急救医学,1999,11(1)：15-17
[43]Ogawa H, Suefuji H, Soejima H, et al. Increased blood vascular endothelial growth factor levels in patients with acute myocardial infarction. Cardiology,2000,93 (1-2):93-99
[44]von Degenfeld G. Raake P, Kupatt C, et al. Selective Pressure-Regulated Retroinfusion of Fibroblast Growth Factor-2 Into the Coronary Vein Enhances Regional Myocardial Blood Flow and Function in Pigs W ith Chronic Myocardial lschemia [J]. J Am Coil Cardiol, 2003.42(6):112()-1128
[45]Zhang C, Yang J, Feng J, et al. Short-term administration of basic fibroblast growth factor enhances coronary collateral development without exacerbating atherosclerosis and balloon injury-induced vasoproliferation in atherosclerotic rabbits with acute myocardial infarction. J Lab Clin Med,2002,140(2):119-125
[46]Fleish M, Billinger M, Eberli FR, Garamehemani AR, Meier B. Seiler c. Physiologically assessed coronary collateral flow and intracoronary growth factor concentrations in patients with 1-to 3-vessel coronary artery disease [J]. Circulation 1999,101(19):1945-950
[47]Grioes CI.Watkins MW. Mahmarian JJ. et al. A Random ized, Double Blind, Placebo Controlled Trial of Ad5FGF-4 Gene Therapy and its Effect on M yocardial Perfusion in Patients with Stable Angina[J]. J Am Coil Cardiot,2003,42(8):1339-1347
[48]Werner GS. Jandt E, Krack A, et al. Growth factors in the collateral circulation of chronic total coronary occtu sions[J]. Circulation,20(14,1 10(14):1940-1945
[49]Brown DM, Hong SP, Farrel CL, et al. Platelet-derived growth factor-BB induced function vascular anastomose in vivo. Proc Natl Acad Sci USA,1995,92:5920-5924
[50]Bobik A. Transforming growth factor-βs and vascular disorders[J]. Arterioscler Thromb Vasc Biol.2006,26(8):1712-1720
[51]Grines C1, Watkins MW, Mahmarian JJ.et al. A Ran-domized, Double-Blind. Placebo-Controlled Trial of Ad5FGF 4 Gene Therapy and its Effect on Myocardial Perfusion in Patients With Stable Angina[J]. J Am Coil Cardiot,2003.42(8):1339—1347
[52]Seiler C, Pohl T, Wustmann K, et al. Promotion of collateral growth by granulocyte-macrophage colony-stimulating factor in patients with coronary artery disease:a randomized, double-blind, placebo-controlled study. Circulation,2001,104(17):2012-2017
[53]崔斌,黄岚,武晓静,等.内皮祖细胞移植对血管内膜修复的影响[J].中国病理生理杂志,2007,23(4)：625-628
[54]张文斌,宋筱筱,方英,等.血管内皮生长因子对外周血内皮祖细胞功能的影响[J].中国病理生理杂志,2007,23(10)：1896-1899
[55]KocherAA, SchusterMD, SzabolcsMJ, et al. Neovascularization of ischemic myocardium by human bone-marrow-derived angioblasts p revents cardiomyocyte apoptosis, reduces remodeling and imp roves cardiac function [J]. NatMed,2001,7 (4):430-436
[56]Kawamoto A, Gwon HC, Iwaguro H, et al. Therapeutic potential of ex vivo expanded endothelial p rogenitor cells formyocardial ischemia [J]. Circulation,2001,103 (5):634-637
[57]Sharma HS, Sassen L, Knoll R, et al. Myocardial expression of vascular endothelial growth factor:enhanced transcription during ischemia and reperfusion [J]. Circulation,1992,86 (supplI):1165-1168
[58]Yamamoto K, Takahashi T, Asahara T, et al. Proliferation, differentiation, and tube formation by endothelial progenitor cells in response to shear stress [J]. J App 1 Physiol,2003,95 (5): 2081-2088
[59]Imaizumi S, M iura S. Nishikawa H, et al. Angiotensin Ⅱ type 1 receptor blockers do not promote coronary collateral circulation in patients with coronary artery disease [J]. Hypertens Res,2006.29(3):135-141
[60]Altin T, Kilickap M, Tutar E, et al. The relationship of chronic angiotensin converting enzyme inhibitor use and coronary collateral vessel development [J]. lnt Heart J, 2007.48(4):435-442
[61]Dincer I. Ongun A, Turhan S. et al. Association between the dosage and duration of statin treatm ent with coronary collateral development[J]. Coron Artery Dis,20116,17(6):561-565.
[62]Hiroaki Nishikawa, Shin-ichiro Miura, Bo Zhang.et al. Pravastatin promotes coronary collateral circulation in patients with coronary artery disease[J]. Coronary Artery Disease 2002,13(7)377-381
[63]张树成,吴志奎,王蕾,等.补肾生血和补肾调经方药促进血管生成作用实验研究[J].中医杂志,2000,41(6)：369-37
[64]戴瑞鸿.麝香保心丸对实验性心肌梗塞大鼠心脏的促血管生成作用[J].中成药,2002,(6)：1-5
[65]朱瑾波,李玉鼎.黄芪治疗慢性皮肤溃疡对血管生成过程的机理探讨[J].河北中医,1996,18(4)：21-22
[66]王文健,傅晓东,陈伟华,等.通心络促血管生成作用的实验研究[J].疑难病杂志,2003,2(1)：2-4
[67]The TIM I ⅢB Investigators Effects of tissue p lasm inogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction:results of the TIM I ⅢB trial [J]. Circulation 1994,89:1545-1556.
[68]Boden WE,O Rourke RA, Crawford MH, et al. Veterans Affairs Non-Q-Wave Infarction Strategies in Hosp ital (VANQW ISH) Trial Investigators. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy[J]. N Engl JMed,1998,338:1785-1792
[69]Ragmin F, Fast Revascularisation during Instability in Coronary artery disease Investigators. Invasive compared with non-invase treatment in unstable coronary artery disease:FR ISC Ⅱ p rospective randomisedmulticentre study[J]. Lancet,1999,354 (9180):7082715.
[70]Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (W riting Committee to Revise the 2002 Guidelines for the Management of PatientsW ith Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic EmergencyMedicine [J]. J Am Coll Cardiol,2007,50:e12e157.
[71]Berger PB, Holmes DR J r, Ohman EM, et al. Restenosis, reocclusion and adverse cardiovascular events after successful balloon angiop lasty of occluded versus nonoccluded coronary arteries. Results from the multicentre American research trialwith cilazap ril after angiop lasty to p revent tnmsluminal coronary obstruction and restenosis(MARCATOR) [J]. J Am Coil Cardiol,1996,27:1.
[72]Ivanhoe RJ,WeintraubWS,Douglas JS J r, et al. Percutaneous transluminal coronary angiop lasty of chronic total occlusions. Primary success, restenosis, and longterm clinical follow-up [J]. Circulation,1992,85:106-115.
[73]Han YL.Wang SL, J ingQM, et al. Percutaneous coronary intervention for chronic total occlusion in 1 263 patients:a single-center report [J]. Chin Med J (Engl),2006,11914: 1165-1170.
[74]Weisz G, Moses JW. New percutaneous app roaches for chronic total occlusion of coronary arteries[J]. Expert Rev Cardiovasc Ther,2007,5 (2):231-241.
[75]INDOL FI C, PAVIA M, ANGEL ILLO IF. Drug-E-luting stents versus bare metal stent s in percutaneous coronary interventions (A meta-analysis) [J]. Am J Cardiol,2005,95:1146-1152.
[76]高迎春,马长生,聂绍平,等.冠心病多支病变雷帕霉素洗脱支架置入与冠状动脉旁路移植术的疗效对比[J].临床心血管病杂志,2008,24(2)：91-94
[77]Colonna P, Iliceto S. Myocardial infarction and left ventricular remodeling:results of the CED M trial. CarnitineEcocardiografia Digitalizzata Infarto Miocardico [J]. Am Heart J, 2000,139:124-130.
[78]Mari C, Straus W.Detection and characterization of hibernation myocardium.Nucl Med Commun.2002;23:311-322.
[79]schelbertHR.18F-Deoxyglueose and the assessment of myoeardial viabiliyt.Seminarsin Nuelear Medieine,2002; 11(1):60-69
[80]Lueiginani G. Landoni C, Paolini G,et al.Positron emmission tomography for The assessment of myocardial viability:a synopsis of methods and indications.Rays.1999:24:81-95.
[81]Werner GS, Surber R, Kuethe F, et al. Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion[J]. Am Heart J,2005,149:129-137.
[82]Kilian JG, keech A, Adams MR, et al. Coronary collateralization:determinants of adequate distal vessel filling after arterial occlusion. Coron Artery Dis,2002,13(3):155-159
[83]Koerselman J, de Jaegere PP. Verhaar MC. et al. High blood pressure is inversely related with presence and extent of coronary collaterals[J]. J Hum Hypertens,2005,19(1):809-817
[84]Van Belle E, Rivard A, Chen D, et al. Hypercholesterolemia attenuates angiogenesis but does not preclude augmentation angiogenic cytokines. Circulation,1997,96:2667-2674
[85]Pohl T, Seilar C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease. Am Coll Cardiol,2001,38(7):1872-1878
[86]Kiemeneij F, L aarman GJ. Percutaneous transradial artery approach fo r co ronary Palmaz-Schatz stent imp lantation [J]. Am Heart J,1994,128:167-174.
[87]Yakoyama N, Takeshita S, Ochiai, et al. Anatomic variations of the radial artery in patients undergoing transradial coronary intervention [J]. Catheter Cardiovasc Interv,2000,49 (2): 357-362.
[88]Serruys PW. Comparison of coronary artery bypass Surgery and stenting for the treatment of multivessel disease. N Engl J Med,2001,344:1117
[89]Rodriguez A, Bernardio V, Navia J, et al. Argentine randomized study:Coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI Ⅱ):30-day and one-year follow up results. J Am Coll Cardiol,2001,37:51
[90]Hannan EL, Racz MJ, Walford G.. Long-term outcomes of coronary-artery bypass grafting versus stent implantation; N Engl J Med,2005,2174-8
[91]Favarato ME, Hueb W, Boden WE. Quality of life in patients with symptomatic multivessel coronary artery disease:a comparative post hoc analyses of medical, angioplasty or surgical strategies-MASS Ⅱ trial; Int J Cardiol,2007,364-70.
[92]Ferguson TB Jr, Hammill BG, Peterson ED. A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures,1990-1999:a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons; Ann Thorac Surg,2002,480-9.
[93]Schweiger MJ,Cannon CP,Murphy SA,et al.Early coronary intervertion following pharmacologic therapy for acute myocardial infarction the combined TIMI 10B-TIMI-14B experince[J].Am J Cardiol,2001,88:831-836.
