CDD CDD CDD CDD

维普资讯 http://www.cqvip.com
解放军医学杂志 2
0
0
5年 7旦 笙 鲞 笙 !塑 ・
论 著
:
垒 ・ !!
!
587 ・
・
Cor
onar
y art
ery t
ri
pl
e ves
s
el
l
es
i
on:cl
i
ni
cal
anal
ys
i
s
of
68 c
as
es Ya
ng Zhi
hu
i
Qi
u Ji
a
n Abs
t
r
ac
t
Ob
j
ec
t
i
ve
To
s
t
udy t
he
c
l
i
ni
c
al
c
ha
r
act
er
s
of
c
or
onar
y ar
t
er
y t
ipl
r
e
ve
ss
el
l
e
si
on.a
nd t
o pr
ovi
de
a
t
he
or
et
i
c
al
ba
si
s
f
0r
t
he t
her
-
a
Dv
t
o t
he
di
s
eas
e.
Me
t
hods
The cl
i
ni
c
al
dat
a of
68
ca
se
s
of
cor
onar
y ar
ter
y t
ipl
r
e
ves
sel
l
es
i
on (
gr
o up A)and 71
c
ase
s
of
or
c
on
ar
y a
r
t
er
y of
s
i
ngl
e or
doubl
e
ves
se
l
l
e
si
on (gr
o up
B) wer
e
anal
yz
ed r
et
o spe
r
ct
i
vel
y.
Re
s
ul
t
s
The
r
e
l
at
d r
e
isk f
act
or
s (hyper
tensi
on,
hype
rl
i
pi
demi
a,di
abet
e
s and smoki
ng)and t
he cl
ust
er
ing of
t
hes
e f
act
or
s
we
re
not
s
i
gni
f
i
a nt
c
l
y di
f
f
er
e
nt
be
t
wee
n t
he
t
wo
gr
oups(P> 0.05).W hi
l
e
t
he
I
X)
s
i
t
i
ve r
at
e of
t
he
exer
c
i
se
st
r
es
s
t
es
t
e
xi
s
t
d r
e
e
mar
kabl
e di
f
f
er
enc
e bet
we
e n t
he
t
wo gr
oups(P< O.01).The
ext
r
e
me
di
f
f
e
r
ence
s
b
et
we
e n t
he
t
wo gr
o ups
ex
ist
d e
al
s
o i
n t
he
c
ase
s
of
bui
l
di
ng ol
c
l
at
er
al
c
i
r
c
ul
a
t
i
on (
P< O.001),and i
n LVEF and LVEDP (P< D
0.0001
)de
monst
r
at
d e
by l
e
f
t
vent
icul
r
ar
angi
ogmphy.The
m
aj
or
it
y of
t
he or
c
onar
y ar
ter
y l
e
si
on i
n gr
oup
A wa
s on l
evel
I
V,and muc
h i
l
K)
r
e
l
e
si
ons
of
l
e
vel
Ul
and l
evel
I
V occ
ur
r
d e
i
n gr
oup A t
han i
n
gr
oup
1
3
.
Most
pat
i
e
nt
s i
n gr
o up A ac
cept
d t
e
he or
c
on
ar
y i
nt
er
ve
nt
i
on,
CD
whi
l
e a
f
t
er
oper
at
i
on
t
he a
ngi
na p
ect
or
is
emer
ge
d i
n a hi
gh r
at
e.t
hen t
he
r
ebui
l
di
ng of
or
c
o nar
y c
i
r
c
ul
a
t
i
on
had t
o e done.C帅 dI
b
i
啊 The
be
st
t
r
e
at
me
nt
f
or
t
he pat
i
ent
s
wi
t
h c
or
on
ar
y ar
te
y t
r
ipl
r
e
ve
ss
el
l
e
si
on s
houl
d b
e t
he op
er
at
i
on of
c
or
on
ar
y ar
ter
y bypas
s gr
af
t
(
CABG)。i
f
i
f
s poss
i
bl
e
.
Ke
y wol
ds c
or
on
ar
y di
s
eas
e ;c
or
o nar
y a
ngi
ogr
aphy;t
ipl
r
e
ve
ss
el
l
es
i
on;ve
nt
r
i
c
ul
ar
f
unct
i
on,l
ef
t
CLC Numh
cr
R654.33 D
冠状动脉三支病变 6
8例临床分析 摘
要 目的
邱
建 CD
羊志辉
分析冠状动脉三支病变的临床特点 ,
为该类患者的治疗提供理论依据。方法 回顾性对 比分析经冠状动脉造影 明确为冠脉三支病变的患者 6
8例及冠脉单支或双支病变 7
1例的临床资料 。结果 三支病变组患者与单双支病变组四种高危 因素 (
高血压 、
高血脂 、
糖尿病 、
吸烟 )
及其聚集性未见显著性差异(
P>O
.
0
5)
。三支病变组运动平板试验的阳性率 (
2
3
/
2
4)
显著高于单双支 病变组(
2
6
/
4
2,
P<O
.
0
1
),
两组侧支循环建立情况及左室造影的 I
VEF、
LVEDP值 比较均有显著性差异(
P<O
.
0
01
),
三支病变组冠脉 发生率及需再次行血运重建 比例较高。结论
条件允许时 ,
冠状动脉三支病变患者 目前应首选冠脉搭桥手术(
CABG)
治疗 。
冠状动脉疾病 ;
冠状动脉造影术 ;
三支病变 ;
心室功能 ,
左 中国图书资料分类号
CD
关键词
D
病变以 I
V级为主 ,
发生 Ⅲ级和Ⅳ级病变的处数较单双支病变组 显著增多 ,
三支病变组 4
8
/6
8例 患者接受 了介入 治疗 ,
但术后 心绞痛 R6
5
4
.
3
3
The
pr
e
sent
ar
ti
c
l
e cl
i
ni
al
c
l
y anal
yz
d 68 pat
e
i
ent
s whos
e
al
l
m,I
V)
,and e
ver
y c
ont
i
nuous st
en
os
i
s
ves
sel
was
na
me
d one
l
e
si
on.
1
ef
t
c
i
r
cumf
l
e
x or
c
on
ar
y ar
ter
y ,LCX;and f
ight
c
or
o nar
y ar
ter
y,
1.
3 Ot
her
di
agnos
i
s st
andar
d D
i abe
t
es:Acc
or
di
ng t
o t
he
annual
RCA ) had pat
hol
ogi
al
c
l
y change
d , and c
o mpar
d t
e
hem wi
t
h di
a
gnost
i
c st
anda
rd
of
W H0 1
998。i
f
t
he
bl
ood s
ugar
of
empt
y anot
he
r
71
c
as
es
who suf
f
e
r
d si
e
ngl
e
or
d
oubl
e
m
a i
n c
or
on
ar
y s
t
om
a ch ̄ 7.0mr
nol
/L and(
or
)t
he s
ympt
om r
andom bl
ood s
ugar
D
t
hr
e or
c
onar
y ar
ter
ie
s (1
e
f
t
ant
er
ior
des
c
endi
ng c
or
o nar
y , LAD;
≥ l1.1mmol
/I
or
2HPG≥ l1.1r
r
m ̄l
/L i
n O rr,t
he
pat
i
ent
gui
dance
t
o t
he
cl
i
ni
cal
do
ct
or
s
f
or
t
he
e p
s
at
i
ent
s
t
r
at
e
ment
.
s
houl
d b
e di
a
gnos
ed w
it
h t
he di
ab
et
e
s[
.
CD
ar
ter
ies
l
es
i
on,
s
o t
hat
t
he
r
es
ul
t
s
c
an pr
ov
i
de
I
l
K)
r
e
t
he
or
et
i
c
al
1
ai
ni
cal
dat
a Hyp
er
tensi
on:Under
t
he
o ndi
c
t
i
on of
aki
t
ng no me
di
c
i
ne。t
he bl
ood pr
es
sur
e
t
hat
i
s
me
a sur
d e
i
n di
f
f
er
ent
da
ys
r
ac
e
he
s an aver
a
ge 1.1
Pat
i
ent
s
Fr
om June
1
998
t
o June 2003。68
pat
i
e
nt
s(
58 me
n val
ue and r
epea
t
s I
l
K)
r
e t
han
t
i ce:s
w
yst
ol
i
c
pr
es
sur
e≥ 1
40mmHg and 1
0 women,age
d f
o m r
43
t
o
85,w
it
h an a
ver
a
ge
of
6
3)wer
e and (
or
)di
as
t
ol
i
c pr
es
sur
e≥ 90mmHgg
.
di
agnos
d e
i
n t
he
Gene
r
al
Hospi
t
al
of
Gua
ngz
hou Mi
l
i
t
ary
Ar
a e
as Hyper
l
i
pi
de
mi
a:To det
er
mi
ne t
he pat
i
ent
s
by a
n y of
t
he
or
c
on
ar
y ar
te
y t
r
ipl
r
e
ve
ss
el
l
e
si
on (gr
o up A )
by c
or
on
ar
y f
ol
l
ow
in
g :s
er
um chol
est
er
ol> 5.72mr
nol
/L。or
se
u m LDH > r
i
nt
e
v ent
r
i
on. Thes
e
p
at
i
ent
s wer
e
c
o mp
ar
d w
e
it
h anot
he
r
71
3.64mmol
/L。or
s
er
um gl
yc
er
i
de> l_7mr
n
ol
/L.
pa
t
i
ent
s(53
me
n and 18
women,age
d f
o m 35 t
r
o 77, w
it
h an Smoker:T
o s
moke 10 ci
gar
e
t
t
es
orI
n
or
e e
ver
y day.
aver
a
ge of
61
)di
agnos
e
d by c
or
o na
y r
ar
te
y a
r
ngi
ogr
aphy as
s
i
gl
n
e Exe
r
ci
s
e s
t
r
es
s
t
ext
p
o si
t
i
ve: 1) Angi
na pec
t
or
is
appear
s
or
doubl
em
a i
n or
c
on
ar
y ar
te
y l
r
e
si
on (
gr
o upB)
.
1.2
Di
a
gnos
i
s
s
t
a
ndar
d f
or
c
or
o nar
y ar
t
e
y st
r
enos
i
s
Le
f
t
or
ight
f
c
or
on
ar
y ar
te
y was
r
x-r
aye
d f
o m r
di
f
f
er
e
nt
bodyp
os
i
t
i
ons
a
nd B1
孽呐
:Ya
ng
Zh
i
hui
, MI
V
t, r
e
s
e
ar
c
h d
i
r
e
ct
i
on:b
as
i
c
a
nd c
l
i
n
i
c
al
researche
s on angi
ocar
iopat
d
hy  ̄
t
i
o
a:Na
nf
an
g Me
di
c
al
Un
iv
e
r
s
i
t
y (n
ow wor
ke
d
i
n
Me
di
c
al
di
f
f
er
ent
di
r
e
ct
i
ons
by j
udki
ng'
s
c
or
onar
y ar
ter
y a
ngi
ogr
aphy,and Depar
tment,Nati
onal
Un
ivers
i
ty of
D
ef
ense Te
chnol
ogy。Changs
ha,Huna
n t
he
s
t
e
nos
i
s deg ̄ (< 25
,
26~ 5O ,51~ 75 ,
76~ 1
00
)of
410073)(Yang Zh
ihui
);General
Hospi
tal
of Guangzhou M i
l
i
tary Command t
he
c
ul
pr
it
l
e
s
i
on wer
e
acc
or
di
ngl
y cl
as
s
i
f
i
d e
i
nt
o f
our
gr
a
des(
I,
1
I,
(
Qi
u
J
i
a
n)
维普资讯 http://www.cqvip.com
・
y 2
0
05
解放军医学杂志 2
005年 7月 第 3
o卷 筹 7期 Me
l
a
—
J
Ch
i
n
PLA Vol30 No 7 Jul
588 ・
—
dur
ing t
he spor
t
mot
i
on; 2) ST s
egme
nt
of
l
evel
t
ype
or
l
a
y-
oron
c
ar
y ar
t
er
ies(LAD,LCX,RCA)mai
nl
y i
n I
V gr
ade,whi
l
e
obl
i
que
t
yp
e s
hi
f
t≥ 0.1
my dur
in
g or
af
t
er
t
he s
or
p
t,or
a
not
her
t
he o mbi
c
at
n
i
on it
w
h st
e
nos
i
s
of
l
ef
t
a i
m
n t
r
unk (
LMT)wa
s
f
ound 0.1mv de
cl
i
ne
f
ol
l
owe
d t
he
or
i
gi
hal
de
cl
i
ned ST s
e
m ent;3)The g
on
l y i
n 5
pat
i
e
nt
. s
bl
ood pr
es
sur
e de
cl
i
ne
s
a
bout
10.31mm Hg dur
i
g n
t
he sp
or
t on t
he basi
s
of
t
he
bl
ood pr
es
sur
e bef
or
e
t
he
spor
t mot
i
or
L
酬
1
.4 Obs
er
vat
i
on met
hod and anal
ysi
s
To a
na
l
yz
e
t
he
di
f
f
er
e
nces
ves
s
el
l
esi
on gr
oup(
The
st
e
nos
i
gs
de
gre was
al
c
cul
at
d e
it
w
h e 2
The
cl
ass
i
f
i
at
c
i
on of
t
he
cul
pr
it
l
e
si
on i
n t
he t
ipl
r
e
of
pat
hogeni
c
f
a
ct
or
s
ex
i
st
e
d b
et
ween t
he
t
wo gr
oups
of
c
or
on
ar
y t
he
most
s
e
ver
e
l
es
i
on)
ar
ter
y di
s
eas
e ( hy
per
tensi
on, hyp
er
l
i
pi
demi
a, hyper
gl
yc
emi
a,
t
oba
cc
o us
e).T
o c
ompar
e t
he t
wo gr
oups
i
n t
he f
ol
l
owi
ng ways:
t
he
expr
ess
i
ons
of
t
he
c
or
on
ar
y ar
ter
y; t
he
f
i
is
n
he
d exe
r
ci
s
d e
s
t
r
es
s: t
he bui
l
di
ng of
t
he
c
ol
l
at
er
al
c
i
rc
ul
a
t
i
on, and t
he l
ef
t
ve
nt
r
i
c
ul
a
r
e
j
ct
e
i
on f
r
ac
t
i
on (LVEF) or
l
e
f
t
vent
ic
r
ul
ar
end-
di
as
t
ol
i
c pr
es
s
ur
e (LVEDP) by l
ef
t
ve
nt
r
i
cul
a
r
angi
ogr
aphy. T
o anal
yz
e
t
he
degr
e of
t
he
c
or
o nar
y ar
ter
y s
t
enosi
s
i
n t
ipl
r
e
ves
se
l
t
r
at
e
ment
or
c
or
on
ar
y i
nt
er
ve
nt
i
on or
CABG we
r
e f
ol
l
ow-up
2.5
Qua
nt
i
t
y of
st
enos
i
s
l
e
si
on i
n b
ot
h t
ipl
r
e ve
sse
l
gr
oup
and D
t
wo gr
oups
. And t
he
p
at
i
ent
s
who ha
ve
ac
c
ept
d me
e
di
ci
ne
o nt
c
ol
r
gr
o up(t
o def
i
ne
a
c
ont
i
nued
s
t
e
nos
i
s
se
ct
i
on as
a
l
esi
on):
A t
ot
al
of
295
l
e
si
ons
was
o unt
c
e
d i
n t
he 6
8 pat
i
e
nt
s
of
gr
o up八 CD
gr
o up.T
o c
o mpar
e
t
he
numb
er
of
t
he ves
se
l
l
es
i
on be
t
we
e n t
he
Among t
hese
l
es
i
ons, 1
1
1
gr
ade
and I
V gr
ade l
es
i
on wer
e
36 sur
ve
ye
d f
or
one
ye
ar
.
1
.5 St
at
i
s
t
i
c
s
The c
hi
-s
quar
e t
est
was
appl
i
d t
e
o c
o mpa
re
t
he cas
es
.The t
-t
est
was
e
mpl
oye
d t
o pr
oces
s
t
he
dat
a of
o unt
c
i
g.
n
(
12.2%)and
202(6
8.5%),r
es
pe
ct
i
ve
l
y.A t
ot
a1
of
130 1
e
si
ons
was
c
o unt
ed i
n t
he
71
pat
i
ent
s
of
c
ont
ol
r
gr
oup.
Amon
g t
hes
e
l
esi
ons,U
I
gr
ade and I
V gr
a
de
l
e
si
on wer
e
13(10 ) a
n d 7
2 (55.
4 ),r
es
pec
t
i
vel
y.Ther
e wer
e
l
es
s
C
is
r
es
i
n gr
o up A t
ha
n i
n gr
o up B,but
mor
e c
ase
s
w
it
h s
er
ious
l
es
i
ons
i
n t
he
f
o1
T
ne
r
t
han i
n 2
.1
The
ver
y danger
o us
f
a
ct
or
s:No s
i
gni
f
i
cant
di
f
f
e
re
nce
was
t
he
l
at
t
eL The r
es
1
】
】
t
s
ar
e
s
hown i
n t
abl
e
3.
D
f
ound b
et
we
e n gr
o up A a
nd gr
o up B i
n hyper
tensi
on,
hyper
l
i
pi
dem
i a, hyp
er
gl
yc
emi
a
and sm
o ki
g, t
n
he
i
nci
dence
of
3 Qua
nt
i
t
y of
s
t
e
nosi
s
l
es
i
on
s i
n ot
b
h gr
oup A n d a
gr
oup B t
he
o nt
c
ol
r
gr
o up.but
have
no s
t
at
i
s
t
i
c
al
s
i
gn
if
i
cant
di
f
f
er
e
nce (
P > O.05).The
r
e was
no di
s
t
i
ngui
s
he
d di
f
f
er
e
nce
on t
he
c
l
us
t
er
in
g l
eve
l
of
t
he
f
our
f
act
ors
ment
i
one
d ab
o ve et
b
we
e n t
he t
wo gr
o ups.
The r
es
ul
t
s
ar
e
s
hox
vn i
n Ta
bl
e
1.
2.2 CD
hyper
tensi
on,hyp
er
l
i
pi
dem
i a n d s
a
moki
ng was
hi
gher
t
han t
hat
i
n Exer
ci
e s
s
t
r
es
s
t
es
t:Ther
e
we
r
e 24
c
as
es(p
o si
t
i
ve
23
A and B r
epr
esent
group A and gr
oup B,r
espec
ti
vel
y [
9
5
.
8
]
)f
i
is
n
h
d e
e
x
e
r
c
i
s
e
s
t
r
e
s
s
t
e
s
t
i
n
t
he
t
ipl
r
e
ve
s
s
e
l
l
e
s
i
o
n
D
g
oup
r
.Co
mp
a
in
r
g
w
it
h
4
2
c
a
s
e
s(
os
p
i
t
i
v
e
26
E
61
.9
])i
n t
h
e
o nt
c
ol
r
gr
o up,P< O.O1
.
CD
2.3 C
ol
l
at
er
al
ci
r
cul
at
i
on and l
ef
t
ve
nt
ic
r
ul
ar
f
unc
t
i
on:24 c
ase
s
i
n t
he t
ipl
r
e ve
ss
el
l
es
i
on gr
oup (35.3
) had bui
l
t
c
ol
l
at
er
a
l
ci
r
c
ul
at
i
on. I
n t
he
c
ont
ol
r
gr
oup,onl
y 6
pat
i
e
nt
s(8.4
)di
d t
he
s
a
l
ue,P< 0.001
. The ve
nt
ic
r
ul
ar
a
n gi
ogr
aphy: Ther
e
wer
e
14
ca
ses
(20.6
)i
n t
he
t
ipl
r
e
vess
el
gr
oup,I
N EF< 50
,LVEF一 0.5522土 0.11
36 and LVEDP一 9.9706土 3.1857.研 l
i
l
e
i
n c
ont
ol
r
LVEF一 0.6351土 0.11
19 and L 旺 )
P一 7.3944± 3.3954. No (
P< 0.001
).
e
1
C
o mpar
is
o n on t
he
i
nc
i
de
nce
a
nd c
l
ust
er
i
g n
CD
酬
D
s
i
gni
f
i
a nt
c
di
f
f
er
ence
ex
is
t
d e
i
n o mpar
c
is
on et
b
we
e n t
he t
wo
gr
o ups
l
ev
el
of
t
he
f
our
f
ac
t
ors
et
b
we
e n t
he
t
wo gr
o ups
.
2.6 The r
es
ul
t
s
of
t
he t
o w
gr
o ups
ar
e
s
ummar
iz
ed as
f
ol
l
ows:I
n t
he t
r
i
p
l
e
ves
s
el
l
es
i
on gr
oup,28 p
at
i
ent
s(41.2
)suf
f
e
r
d f
e
om r
myo
car
di
u
m i
nf
ar
ct
i
on, 40 pa
t
i
ent
s (58.8
) s
uf
f
er
d f
e
om r
unst
abl
e n gi
a
a p
n
ct
e
or
is,2
pat
i
e
nt
s
a
cc
o mp
an
ie
d wi
t
h hyper
tr
o phi
c
obs
t
r
uc
t
i
ve
c
ar
di
omyop
at
hy a
n d 6
pat
i
e
nts
a
cc
o mpan
ied t
h vent
r
i
cul
ar
n eur
a
ys
m. I
n t
he
c
ont
ol
r
gr
oup,23 p
at
i
e
nt
s(
32.4
)
s
uf
f
e
r
d f
e
o m myo
r
c ar
di
um i
nf
ar
c
t
i
on,
15
pa
t
i
ent
s (21.1
)
s
uf
f
er
d f
e
o m unst
r
abl
e
a
ngi
a pe
n
ct
or
is, 33 pat
i
e
nt
s(46.5
)
s
uf
f
e
re
d f
r
om st
abl
e
angi
a pe
n
ct
or
is
.Bet
we
e n t
he
t
wo gr
o ups,t
he
i
nc
i
de
nce
of
myo
car
di
um i
nf
ar
c
t
i
on di
d not
s
how obvi
ous
di
f
f
e
re
nc
e
(P> O.05),a
nd
t
he
i
nci
de
nc
e of
t
he
uns
t
abl
e
t
yp
e angi
a pe
n
ct
or
is
s
howe
d a
ver
y r
em
a r
kabl
e
di
f
f
e
r
ence (P < 0.001)
.I
n a f
ur
ther
a
na
l
ys
i
s,t
he f
r
equency of
myo
c ar
di
um i
nf
ar
ct
i
on t
at
h
happ
e ne
d et
b
we n t
he t
wo gr
oups
was
ver
y di
f
f
e
re
nt
,i
t
was
f
ound
t
hat
i
n t
he t
r
i
pi
e ves
se
l
l
e
si
on gr
oup,32
.1
(9/28)pat
i
e
nt
s
s
uf
f
er
e
d f
or
m myo
c ar
d
i
um i
f ar
n
ct
i
on t
ic
w
e
or
mor
e,whi
l
e
i
n t
he
si
gl
n
e or
doubl
e ve
ss
el
l
esi
on gr
oup,onl
y 8.7
(2/23)pat
i
ent
s
di
d t
he s
ame(P< 0
.05).The r
es
ul
t
s
ar
e
iven g
i
n t
abl
e 4.
1
hbl
e
4 C
o mp
ar
is
o n on t
he
f
r
equency of
myo
ca
rdi
um i
nf
ar
ct
i
on et
b
we
e n gr
o up A n d a
gr
o up B *No si
gni
f
i
c
ant
dif
f
er
ence exi
ste
d(P> O.05)
2.4 The
cul
pr
it
l
e
si
on i
n t
he
t
ipl
r
e
vess
el
l
es
i
on gr
o up wer
e
gr
o uped i
n t
abl
e
2:The st
enosi
s
l
es
i
on o
ccur
r
d i
e
n al
l
t
he
t
hr
e 维普资讯 http://www.cqvip.com
解 放 军 医学 杂 志 2
005年 7月 第 3
O卷 第 7
30
No
7
Ju
l
y 2
005
Me
d J
Ch
i
n
PLA Vol
—
・ 589 ・
—
2.7 The f
ol
l
ow-up
sur
ve
y t
o t
he
pat
i
e
nt
s
of
t
he t
ipl
r
e ve
ss
e1
c
ure
d e st,a
b
nd f
ew of
t
hem ne
ed t
o be r
et
r
e
at
d e
e
xcept
t
aki
ng l
esi
on gr
oup f
or
one ye
ar
gave
out
t
he
f
ol
l
owi
ng r
e
sul
t
s:t
her
e
wer
e
me
di
ci
ne.
Onl
y one c
as
e
re
ce
i
ve
d myoc
ar
di
a1
r
ev
asc
ul
a
r
i
za
t
i
on.
48 p
at
i
ent
s (7O.6
)r
e
cei
vi
g i
n
nt
e
v ent
r
i
on, f
ar
mor
e
t
han t
he
7O.6
pat
i
ent
s
who r
cei
e
ve
d CABG and me
di
ci
ne
t
r
at
e
me
nt(t
abl
e 5)
.
pl
us
st
e
nt
t
re
at
ment
t
ur
ne
d i
nt
o et
b
t
e
r
o ndi
c
t
i
on,but
t
he r
c ur
e
r
i
g n
Howe
ver.s
ome
of
t
he
pat
i
e
nt
s who had
re
cei
ve
d i
nt
e
v ent
r
i
on and r
at
e
of
a
ngi
a wa
n
s hi
gh and s
o me
pat
i
e
nt
s
w
it
h re-
st
e
nos
i
s
of
t
he me
di
c
i
ne t
r
at
e
ment
di
d and (or) had t
e
o under
go myoc
ar
di
a
l
st
ent
ne
ede
d t
o r
ebui
l
d t
he
bl
ood ve
ss
e1
.s
uc
h a
r
es
ul
t
m
a y 1
i
e
i
n r
evas
cul
ar
iz
at
i
on and myo
ca
r
di
um i
nf
ar
ct
i
on,
whi
l
e
no s
uc
h t
he f
ol
l
ow
i ng t
hr
e
e f
a
ct
or
s:f
i
r
st
l
y,t
he
pat
hol
og
ic
al
ch
an
ge sc
op
e i
nci
de
nt
s happ
ene
d i
n t
he pat
i
ent
s
i t
w
h CABG of
t
ipl
r
e
ve
ss
el
l
e
si
on gr
o up
i
s
va
st; se
condl
y, most
c
or
on
ar
y pat
i
ent
s
r
c ei
e
ve
d t
he
i
nt
er
ve
nt
i
on. Pat
i
ent
s
w
it
h PTCA i
nt
e
vent
r
i
on t
re
at
ment
b
el
on
g t
o i
nc
o mpl
et
e (par
ti
a1
)r
e
bu
i
l
in
d
g of
mI
bk 5 Resul
t
s
of
one
ye
ar
f
ol
l
ow-up sur
v ey t
o t
he pat
i
e
nt
s
bl
ood ve
s se
1,an
d t
ir
h
dl
y,pat
i
e
nt
s
wer
e
not
p
os
i
t
i
ve i
n t
he me
di
a1
c
t
r
at
e
me
nt
on ant
i
-
aggl
ut
i
at
n
i
g me
n
di
c
i
ne,
a
n d de
cr
a si
e
g l
n
i
pi
d of
t
ipl
r
e
ves
se
l
l
e
si
on gr
oup me
di
c
i
ne
t
r
at
e
ment
wa
s not
enough,
wh
ic
h m
a y l
a d t
e
o
t
he
de
vel
op
ment
of
p
at
hol
ogi
c
al
chan
ge
d par
ts
a
n d r
e
-
st
en
os
i
s
of
t
he st
ent
. Ther
ef
or
e, c
o nce
r
ni
g w
n
it
h t
he op
er
at
i
ona1
i
Tl
anner, t
he D
CABG t
r
at
e
ment
woul
d b
e t
he f
i
r
s
t
c
hoi
c
e when t
he c
o nd
it
i
on of
at
p
i
e
nt
s i
s
f
i
t
f
or
s
uch a t
r
at
e
me
nt
.For
e
xampl
e,t
he v
ess
e1
of
t
he
CD
or
c
on
ar
y ar
te
y r
was
bl
ocked ove
r
7
0 ,a
nd t
he di
s
a1
t
ves
se
l
f
o m r
t
he ar
n
r
ow pl
ac
e
ne
ed t
o e b
unobst
u ct
r
d ,al
e
o v
s
ent
ic
r
ul
ar
f
unc
t
i
on i
s
good[
,
except
t
hat
t
he pa
t
i
ent
s
a
sk f
or
t
he c
or
on
ar
y i
nt
e
v ent
r
i
on. Howe
ver,
s
o me
pat
i
e
nt
s st
i
l
l
c
hoos
e t
he
me
di
al
c
of
c
or
on
ar
y ar
t
er
y woul
d b
e i
nf
l
uenc
d by
e
many f
a
ct
or
s,suc
h a
s t
he er
p
iod of
i
l
l
t
i
me,t
he c
ar
di
ova
sc
ul
a
r
ont
ogeny,t
he s
ever
it
y of
o me
s
c
ar
di
ovas
cul
ar
i
nf
l
ar
nmat
i
on, and even t
he da
ma
ge
of
t
he i
mmuni
t
y s
ys
t
e
m. i
t
a
l
o s
i
ndi
at
c
d t
e
hat
synt
hes
i
ze
d anal
ysi
s
shoul
d t
hough t
he e
f
f
ct
e
of
me
di
al
c
t
r
at
e
me
nt
i
s
not
s
o good.The
r
ce
e
nt
r
ese
ar
c
h al
o i
s
ndi
at
c
e t
hat
t
he f
ol
l
ow
i ng dr
u gs
o ul
c
d e b
se
l
ct
e
d :
e
re
c
ept
or
bl
c ki
o
ng a
gent
s, ACH a
gent
s, de
c re
as
i
g l
n
i
pi
d dr
ugs,
n d a
a
nt
i
-t
hr
o mb
o si
s
dr
ugs
. Though t
he ab
ov
e dr
u gs
w
il
1
i
mpr
o ve t
he
st
abi
l
i
t
y of
uns
t
abl
e pl
aque af
t
e
r
r
ep
ai
in
r
g t
he
br
o ken pl
aque,
t
hey o ul
c
dn'
t
i
mp
el
myoc
ar
di
a
1
re
vas
cul
ar
i
z
at
i
on
. Thus,i
t
i
s
it
v
a1
t
o CD
e b
a de
m
on p
at
i
ent
s
it
w
h t
ipl
r
e
ves
sel1
e
si
on.t
hat
i
s.we
mus
t
f
i
nd t
r
at
e
me
nt
bec
ause
of
t
he exp
e ns
i
ve op
er
at
i
on
al
c
ha
n ge
of
CABG.
D
I
t
wa
s i
ndi
c
at
d i
e
n pr
e
se
nt
s
t
udy t
hat
t
he
di
f
f
e
r
ent
sympt
oms t
he
most
i
nf
lue
nt
i
a
l
dan
ger
o us
f
a
ct
or
and t
he
n make
t
he
t
r
at
e
ment
i
nves
t
i
gat
e
on t
he
bi
ol
og
ic
br
i
age
me
di
cal
dr
ug whi
c
h c
oul
d make er
p
ti
ne
nt
l
y
.
The
dat
a
of
t
hi
s
e
xp
er
i
ment
i
ndi
at
c
d t
e
hat
mos
t
of
t
he
or
c
on
ar
y ar
ter
y t
ipl
r
e
ves
se
l
l
es
i
on b
el
on
gs
t
o t
he I
V c
l
a
ss
.
The
up t
he
shor
tc
o mi
ngs
of
c
or
on
ar
y i
nt
er
ve
nt
i
on a
nd t
he
op
er
at
i
on
al
t
r
at
e
ment
.It
i
s
r
ep
or
te
d t
hat
s
uc
h a dr
u g i
s st
i
l
1
i
n r
e
se
ar
ch numb
er
of
t
he I
I
I
an
d IV c
l
a
ss
1
esi
ons
of
t
he t
ipl
r
e
ves
se
1
1
e
si
on Ref
e
r
ence
s
ove
r
pass
e
d t
he s
i
gl
n
e or
doubl
e ve
s
sel
l
es
i
on gr
o up
s
i
gni
f
i
c
nt
a
l
y,
Bo
qi
Gu. Car
d
i
ov
a
s
cu
l
ar
pa
t
hol
o
gy. Bdi
i
ng: Pe
opl
e
s
hyg
i
e
n
i
c
s
n dr
y
ome.I
n t
he
t
ipl
r
e
ves
s
el
l
es
i
on gr
oup,41.1
of
t
hem el
b
on
g publ
i
sh
ing house,1992:58— 59
t
o myo
ca
r
di
um i
nf
a
r
ct
i
on whi
l
e
52.8 b
el
on
g t
o unst
abl
e
an
gi
na Re
n
ga
o Ye
.Cl
i
ic
n
a
l
pr
a
c
t
i
ce(f
if
t
h
e
d
i
t
i
on)
.Be
i
j
i
g :Pe
n
opl
e
'
s
h
yg
ie
ic
n
D
whi
c
h woul
d i
ncr
a se
e
t
he ch&nce
s
of
ac
ut
e c
or
on
ar
y ar
te
y r
publ
i
sh
in
g house,2001,293 CD
pe
ct
or
is,whi
ch ac
c
or
ds
wi
t
h t
he re
por
t t
hat
mos
t
of
di
s
rupt
i
ons
of
Fus
t
e
r
V,ba
imon
d
1
,ba
d
i
mon J
J
e
t
a1
.The
pat
ho
gen
e
s
i
s
of
c
o
r
on
ar
y
t
he pl
aque of
unst
abl
e
angi
a pe
n
ct
or
i
s n d myoc
a
ar
di
um t
ake pl
ac
e i
n a
bout
50 a
r
t
er
yd
is
e
as
e
a
nd t
he
a
cut
e
c
or
on
a
r
y s
ynd
r
ome
s
. N En
gl
J
MED,
a rr
n
ow pa
t
hol
ogi
cal
pl
a
ce
s
of
t
he
c
or
on
ar
y ar
te
ies
r
[
]and I
V c
l
as
s st
e
nosi
s
i
s
t
he
m
a i
n pat
hol
ogi
c
al
bas
i
s
of
myocar
di
um i
f ar
n
ct
i
on[
.
1992;326:242 4 The he
ar
t f
unct
i
on of
most
t
ipl
r
e v
ess
el
l
es
i
on pat
i
e
nt
s
c
an st
i
l
l
wor
k wel
l
, but
t
he st
or
e
s
t
r
en
gt
h of
1995, 92: 657 5 myo
ar
c
di
um i
s not
s
o good. The dat
a of
1
ef
t
vent
icul
r
ar
i
nf
a
r
e
t
i
on.J
Am ol
C
l
Car
d
i
ol
,19
88,12:5
6
D
6 pa
t
i
e
n
t
s
wi
t
h mi
l
d t
o mo
der
at
e
c
or
o
na
r
y a
r
t
e
y d
r
is
e
as
e?C
ir
c
ul
at
i
o
n,
CD
79.4 pat
i
ent
s
it
w
h t
ipl
r
e
ves
se
l
l
es
i
on i
s
l
ar
ger
t
han 50 .Thi
s
ci
r
c
ul
at
i
on i
mpr
o ve
s t
he
myoc
ar
di
m bl
u
ood s
uppl
y ̄
埘 ;s
e
condl
y,
t
he
ar
c
di
ac
mus
cl
e woul
d e b
pr
ot
ct
e
d by e
a
dapt
at
i
on t
o i
s
chemi
a[
.
Li
t
t
l
e
W C, C
on
st
nt
a
i
ne
cu
s
M, Appl
e
gat
e
RJ
e
t
a1
.
Ca
n c
or
o
na
r
y angi ̄ raphy predi
ct
the si
te of
a subsequent
myocard
ia
l i
nf
arc
ti
on i
n pat
i
ent
s
w
it
h si
gl
n
e
or
doubl
e ve
ss
e1
1
es
i
on. but
t
he
LVEF of
a y
m
l
i
e
i
n t
he f
ol
l
ow
in
g r
as
e
o ns:f
i
r
s
t,t
he bui
l
di
g of
n
c
ol
l
at
e
r
al
Ambr
os
e
JA,Ta
nne
nb
au
m MA,Al
ex
op
ou
lo
s
D e
t
a1
.Angi
c
gr
a
ph
ie
progressi
on of or
c
onary art
er
y ise
d
ase i
n the devel
opment
of
myocard
ial
angi
ogr
aphy i
n t
is
h
e
xp
er
i
ment
s
howe
d t
hat
t
he l
e
f
t
ve
nt
ic
r
l
e f
unc
t
i
on of
pat
i
e
nt
s
it
w
h t
ipl
r
e ve
ss
el1
es
i
on was
wor
s
e t
han t
hat
of
刚 k E,Shah PK,Fust
er
v.Coronar
y pl
aque d
is
u pt
r
i
on. Ci
rcu
lati
on.
1988,78:1157 7 Fust
er V, Fr
ye RL, Kennedy M A et
a1. The rol
e of
c
ol
l
atera
l ireul
t
ati
on i
n vari
ous
coronary syndrome.C
ir
cul
at
i
on,1979,59:1137 —
1144 st
unne
d myo
car
di
m and myoc
u
ar
di
um h
ib
e rnat
i
on whi
c
h wer
e
8 Gr
ol
l
i
e
r
G,C
o mme
au P,Fouc
aul
t
J
P e
t
a1
. Ang
i
opl
a
s
t
y
of
c
hr
o
ic
n
a us
c
d by t
e
he i
sc
he
mi
a
i
n di
f
f
e
r
ent
par
ts
. As
t
o t
he f
i
ni
s
he
d t
ot
ll
a
y o
c
c
l
ud
d e
or
c
on
ar
y
ar
t
e
r
i
s :us
e
ef
u
l
n
e
s
s
o
f
r
e
t
r
o
gr
a
de
o
pa
c
i
ic
f
at
i
on exer
c
i
s
e
t
est
i
g ,t
n
he
r
at
e
of
t
he t
ipl
r
e
ves
se
l
1
si
e
on t
o posi
t
i
ve
of the occl
ude
d vessel
vi
a t
he cont
ra
lat
era
l c
or
onary arter
y
obvi
ousl
y hi
gher
t
ha
n t
hat
of
t
he t
wo ves
el
s
l
si
e
on gr
o up,wh
ic
h J,1
987,11
4:13
24— 1
32
8 a y m
e due
b
t
o t
he
vas
t
p
at
hol
og
ic
al
chan
ge s
c
op
e of
t
ipl
r
e
ves
se
l
l
e
si
on gr
o up t
hat
a n c
l
a d t
e
o s
t
or
e s
t
r
engt
h of
myoc
ar
di
um ,whi
c
h i
n t
ur
n il
w
l
e
as
i
l
y r
e
sul
t
i
n t
he i
s
chemi
a
whe
n pl
ayi
g.
n
Mor
e
over,i
n t
he f
ol
l
ow-
up vi
s
i
t
s
t
o t
he pat
i
e
nt
s
w
it
h t
ipl
r
e ves
s
 ̄l
l
es
i
on we f
ound t
hat
t
he
at
p
i
e
nt
s
wi
t
h CAI
3
G t
r
at
e
me
nt
wer
e .
9 Pa
r
r
a
t
t
J
R T_
he
Di
s
∞v
er
y
of
I
s
c
he
c
Pr
ec
0
ndi
t
I
o
ni
n Am Hear
t Ca
l
av
a
S
c
Res,1993,27:688 (2
OO5
一
O3
—
22收稿
2OO
5一
O6一
O8修回)
(
本文编辑
张金桐)