Mathew V, Berger P B, Lennon R J, Gersh B J, Holmes D R
Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Cardiol. 2000 Nov 1;86(9):931-7. doi: 10.1016/s0002-9149(00)01125-5.
An increasing number of patients who have undergone previous coronary artery bypass grafting (CABG) are referred for percutaneous coronary revascularization. We identified patients who underwent percutaneous intervention for unstable angina from 1990 to 1998 at our institution and assigned them into 2 groups based on whether or not they had undergone previous CABG. There were 1,431 patients with and 4,629 patients without previous CABG. Previous CABG patients were older, had more atherosclerotic risk factors, more heart failure, lower ejection fraction, more multivessel disease, more multilesion treatment, more complex lesions, and less complete revascularization. Adjusting for baseline differences, previous CABG was associated with worse long-term mortality (RR 1.47, 95% confidence intervals [CI] 1.22 to 1.77, p < 0.001) and death, myocardial infarction, and/or revascularization (RR 1.16, 95% CI 1.04 to 1.30, p = 0.01); treatment of native lesions in patients with previous CABG versus treatment of vein graft lesions was associated with a reduction in this composite end point (RR 0.75, 95% CI 0.65 to 0.87, p < 0.001). Post-CABG patients treated between 1995 and 1998 had lower long-term mortality (RR 0.76, 95% CI 0.59 to 0.99, p = 0.04) and death, myocardial infarction, and/or revascularization (RR 0.76, 95% CI 0.66 to 0.88, p < 0.001) compared with those treated between 1990 and 1994. Thus, in patients with unstable angina referred for percutaneous revascularization, previous CABG is associated with reduced event-free survival, although the outcome of post-CABG patients treated from 1995 to 1998 is superior to that observed in patients treated from 1990 to 1994. In patients who underwent previous CABG, treatment of native lesions affords better long-term outcome than vein graft intervention.
越来越多曾接受过冠状动脉旁路移植术（CABG）的患者被转诊接受经皮冠状动脉血运重建治疗。我们确定了1990年至1998年在我们机构因不稳定型心绞痛接受经皮介入治疗的患者，并根据他们是否曾接受过CABG将其分为两组。有1431例曾接受过CABG的患者和4629例未接受过CABG的患者。曾接受过CABG的患者年龄更大，有更多的动脉粥样硬化危险因素、更多的心衰、更低的射血分数、更多的多支血管病变、更多的多病变治疗、更复杂的病变以及更低的完全血运重建率。校正基线差异后，曾接受过CABG与更差的长期死亡率相关（风险比[RR]1.47，95%置信区间[CI]1.22至1.77，p<0.001）以及与死亡、心肌梗死和/或血运重建相关（RR1.16，95%CI1.04至1.30，p = 0.01）；与治疗静脉移植血管病变相比，治疗曾接受过CABG患者的自身病变与该复合终点的降低相关（RR0.75，95%CI0.65至0.87，p<0.001）。1995年至1998年接受治疗的CABG术后患者与1990年至1994年接受治疗的患者相比，长期死亡率更低（RR0.76，95%CI0.59至0.99，p = 0.04）以及死亡、心肌梗死和/或血运重建率更低（RR0.76，95%CI0.66至0.88，p<0.001）。因此，在因不稳定型心绞痛被转诊接受经皮血运重建治疗的患者中，曾接受过CABG与无事件生存率降低相关，尽管1995年至1998年接受治疗的CABG术后患者的结局优于1990年至1994年接受治疗的患者。在曾接受过CABG的患者中，治疗自身病变比静脉移植血管介入能带来更好的长期结局。
