Okada H, Tsurumi Y, Kasanuki H, Nishida H, Endo M
Department of Cardiology, Heart Institute of Japan, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo 162-8666.
J Cardiol. 2001 Sep;38(3):111-21.
The incidence of percutaneous coronary intervention following bypass surgery(coronary artery bypass grafting: CABG) is not low, but the outcomes of patients requiring percutaneous coronary intervention after CABG are not well known.
From June 1970 to June 2000, 2,981 patients underwent CABG at our institute using 6,747 grafts including 2,875 saphenous vein graft(SVG), 3,042 internal thoracic artery(ITA), 706 gastro-epiploic artery(GEA), 122 radial artery(RA), and 2 others. Three hundred twenty-seven patients underwent subsequent percutaneous coronary intervention in 520 lesions(104 SVG, 97 ITA, 12 GEA, 8 RA, 299 native artery). The initial results and long-term outcome following percutaneous coronary intervention in these 520 consecutive procedures were evaluated retrospectively.
Percutaneous coronary intervention to arterial grafts were performed mainly within the early post-operative period, whereas percutaneous coronary intervention to vein grafts had two periodic peaks in the early post-operative period and at 7 years after CABG. Procedural success rate of percutaneous coronary intervention was 90% for SVG, 81% for ITA, 58% for GEA, 88% for RA, and 87% for native arteries. Restenosis rate was 56% for SVG, 30% for ITA, 83% for GEA, 83% for RA, and 49% for native arteries. Cardiac events after percutaneous coronary intervention with previous CABG were greater in cases of ITA, followed by native arteries, SVG, GEA and RA(p = 0.0046). In the early post-operative period, there was no significant difference between ITA and SVG. In the chronic stage, the prognosis of cardiac events after PCI for SVG was worse than for ITA.
Percutaneous coronary intervention after CABG requires strategic consideration based on target-specific initial results and long-term outcome.
冠状动脉旁路移植术（CABG）后经皮冠状动脉介入治疗的发生率并不低，但CABG后需要经皮冠状动脉介入治疗的患者的预后情况尚不清楚。
1970年6月至2000年6月，我院对2981例患者行CABG，共使用6747根移植血管，其中包括2875根大隐静脉移植血管（SVG）、3042根胸廓内动脉（ITA）、706根胃网膜动脉（GEA）、122根桡动脉（RA）及其他2根。327例患者对520处病变（104处SVG、97处ITA、12处GEA、8处RA、299处自身动脉）进行了后续经皮冠状动脉介入治疗。对这520例连续手术的经皮冠状动脉介入治疗的初始结果和长期预后进行回顾性评估。
对动脉移植血管的经皮冠状动脉介入治疗主要在术后早期进行，而对静脉移植血管的经皮冠状动脉介入治疗在术后早期和CABG后7年有两个高峰期。经皮冠状动脉介入治疗的手术成功率：SVG为90%，ITA为81%，GEA为58%，RA为88%，自身动脉为87%。再狭窄率：SVG为56%，ITA为30%，GEA为83%，RA为83%，自身动脉为49%。既往有CABG史的患者经皮冠状动脉介入治疗后的心脏事件在ITA病例中较多，其次是自身动脉、SVG、GEA和RA（p = 0.0046）。在术后早期，ITA和SVG之间无显著差异。在慢性期，SVG经皮冠状动脉介入治疗后心脏事件的预后比ITA差。
CABG后的经皮冠状动脉介入治疗需要根据特定靶点的初始结果和长期预后进行策略性考虑。
