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在搭桥血管成形术血运重建研究（BARI）中，血运重建范围与一年时心绞痛的关系。

Relationship of extent of revascularization with angina at one year in the Bypass Angioplasty Revascularization Investigation (BARI).

作者信息

Whitlow P L, Dimas A P, Bashore T M, Califf R M, Bourassa M G, Chaitman B R, Rosen A D, Kip K E, Stadius M L, Alderman E L

机构信息

Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA.

出版信息

J Am Coll Cardiol. 1999 Nov 15;34(6):1750-9. doi: 10.1016/s0735-1097(99)00406-4.

DOI:10.1016/s0735-1097(99)00406-4

PMID:10577566

Abstract

OBJECTIVES

To determine the relative degree of revascularization obtained with bypass surgery versus angioplasty in a randomized trial of patients with multivessel disease requiring revascularization (Bypass Angioplasty Revascularization Investigation [BARI]), one-year catheterization was performed in 15% of patients.

BACKGROUND

Complete revascularization has been correlated with improved outcome after coronary artery bypass grafting (CABG) but not with percutaneous transluminal coronary angioplasty (PTCA). Relative degrees of revascularization after PTCA and surgery have not been previously compared and correlated with symptoms.

METHODS

Consecutive patients at four BARI centers consented to recatheterization one year after revascularization. Myocardial jeopardy index (MJI), the percentage of myocardium jeopardized by > or =50% stenoses, was compared and correlated with angina status.

RESULTS

Angiography was completed in 270 of 362 consecutive patients (75%) after initial CABG (n = 135) or PTCA (n = 135). Coronary artery bypass grafting patients had 3+/-0.9 distal anastomoses and PTCA patients had 2.4+/-1.1 lesions attempted at initial revascularization. At one year, 20.5% of CABG patients had > or =1 totally occluded graft and 86.9% of vein graft, and 91.6% of internal mammary artery distal anastomotic sites had <50% stenosis. One year jeopardy index in surgery patients was 14.1+/-11%, 46.6+/-20.3% improved from baseline. Initial PTCA was successful in 86.9% of lesions and repeat revascularization was performed in 48.4% of PTCA patients by one year. Myocardial jeopardy index one year after PTCA was 25.5+/-22.8%, an improvement of 33.8+/-26.1% (p<0.01 for greater improvement with CABG than PTCA). At one year, 29.6% of PTCA patients had angina versus 11.9% of surgery patients, p = 0.004. One-year myocardial jeopardy was predictive of angina (odds ratio 1.28 for the presence of angina per every 10% increment in myocardial jeopardy, p = 0.002). Randomization to PTCA rather than CABG also predicted angina (odds ratio 2.19, p = 0.03).

CONCLUSIONS

In this one-year angiographic substudy of BARI, CABG provided more complete revascularization than PTCA, and CABG likewise improved angina to a greater extent than PTCA.

摘要

目的

在一项针对需要血运重建的多支血管病变患者的随机试验（旁路血管成形术血运重建研究[BARI]）中，为确定旁路手术与血管成形术实现的血运重建相对程度，对15%的患者进行了为期一年的导管插入术。

背景

完全血运重建与冠状动脉旁路移植术（CABG）后改善的预后相关，但与经皮腔内冠状动脉成形术（PTCA）无关。此前尚未比较PTCA和手术术后血运重建的相对程度并将其与症状相关联。

方法

来自四个BARI中心的连续患者在血运重建一年后同意再次进行导管插入术。比较心肌危险指数（MJI），即因狭窄≥50%而处于危险中的心肌百分比，并将其与心绞痛状态相关联。

结果

在最初接受CABG（n = 135）或PTCA（n = 135）的362例连续患者中，270例（75%）完成了血管造影。冠状动脉旁路移植术患者在初次血运重建时有3±0.9个远端吻合口，PTCA患者有2.4±1.1个病变接受了治疗。一年时，20.5%的CABG患者有≥1个完全闭塞的移植物，86.9%的静脉移植物以及91.6%的乳内动脉远端吻合部位狭窄<50%。手术患者一年时的危险指数为14.1±11%，较基线改善了46.6±20.3%。初次PTCA在86.9%的病变中成功，到一年时48.4%的PTCA患者进行了再次血运重建。PTCA术后一年的心肌危险指数为25.5±22.8%，改善了33.8±26.1%（CABG的改善程度大于PTCA，p<0.01）。一年时，29.6%的PTCA患者有心绞痛，而手术患者为11.9%，p = 0.004。一年时的心肌危险可预测心绞痛（心肌危险每增加10%，心绞痛发生的优势比为1.28，p = 0.002）。随机分配至PTCA而非CABG同样可预测心绞痛（优势比2.19，p = 0.03）。