Lazar H L, Bao Y, Lancaster D, Shapira O M, Aldea G S, Shemin R J
Department of Cardiothoracic Surgery, Boston Medical Center, and Boston University School of Medicine, Massachusetts 02118, USA.
Ann Thorac Surg. 1999 Nov;68(5):1644-7. doi: 10.1016/s0003-4975(99)00767-5.
This study was undertaken to determine the impact of the use and availability of coronary stents on outcomes in patients requiring emergent coronary artery bypass graft (CABG) surgery following a failed percutaneous transluminal coronary angioplasty (PTCA).
Patients were divided into two groups based on the year of their CABG for a failed PTCA and the availability of stents: group 1, 1992 to 1994, stents not available (n = 34); and group 2, 1995 to 1997, stents available (n = 26).
CABG patients in the group where stents were not available were more likely to have had an abrupt coronary occlusion (26 of 34 versus 3 of 26; p < 0.0001) and less likely to have had a dissection (8 of 34 versus 23 of 26; p < 0.0001) as their indication for emergent CABG. Patients in the stent era had a lower incidence of perioperative myocardial infarction (5 of 26 versus 17 of 34; p < 0.01) and a decreased mortality rate (0 of 26 versus 6 of 34; p < 0.03). In the 9 patients where stents were employed, patency of the lumen was restored in 8 patients and there was only 1 myocardial infarction.
Stents have had a favorable impact on patients requiring an emergent CABG following a failed PTCA.
本研究旨在确定冠状动脉支架的使用和可获得性对经皮腔内冠状动脉成形术（PTCA）失败后需要紧急冠状动脉旁路移植术（CABG）的患者预后的影响。
根据因PTCA失败而进行CABG的年份以及支架的可获得性，将患者分为两组：第1组，1992年至1994年，无支架可用（n = 34）；第2组，1995年至1997年，有支架可用（n = 26）。
无支架可用组的CABG患者更有可能因冠状动脉突然闭塞（34例中的26例与26例中的3例；p < 0.0001）而接受紧急CABG，而因血管夹层（34例中的8例与26例中的23例；p < 0.0001）接受紧急CABG的可能性较小。支架时代的患者围手术期心肌梗死发生率较低（26例中的5例与34例中的17例；p < 0.01），死亡率也有所降低（26例中的0例与34例中的6例；p < 0.03）。在使用支架的9例患者中，8例患者的管腔恢复通畅，仅发生1例心肌梗死。
支架对PTCA失败后需要紧急CABG的患者有积极影响。
