[Treatment of ischemic heart disease--coronary surgery or angioplasty? An evaluation based on clinical and experimental data].
Coronary artery bypass graft surgery relieves angina and increases survival in patients with left coronary main stem stenosis or multivessel-disease associated particularly with reduced ventricular function. However, percutaneous transluminal coronary angioplasty (PTCA) has been developed as an alternative procedure for revascularization of ischemic myocardium. No large, prospective studies comparing PTCA and surgery have been published. Based on present knowledge, surgery is probably to be preferred in patients with multivessel-disease (two-vessel and three-vessel disease) associated particularly with reduced left ventricular function. Complete revascularization is a beneficial factor which reduces ischemic incidents and increases survival in these patients. With PTCA, complete revascularization is often impossible, owing to technical difficulties and procedure-related morbidity. PTCA is also associated with an approximately 45% restenosis rate of dilated lesions. Improved function after reperfusion of myocardium with reversibly reduced contractility (stunned and hibernating myocardium), also indicates the benefit of complete revascularization. Owing to a potential fatal occlusion with PTCA, a left coronary main stem stenosis is also best treated surgically.
Myrmel
T
T
Kirurgisk avdeling Regionsykehuset i Tromsø.
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D005069:Evaluation Studies as Topic; D006801:Humans; D008955:Models, Cardiovascular; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis
Behandling av iskemisk hjertesykdom--koronarkirurgi eller angioplastikk? En vurdering basert på kliniske og eksperimentelle data.