Mehta Rajendra H, Honeycutt Emily, Peterson Eric D, Granger Christopher B, Halabi Abdul R, Shaw Linda K, Smith Peter K, Califf Robert M, Harrington Robert A, Sketch Michael H
Division of Cardiology, Department of Internal Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
Circulation. 2006 Jul 4;114(1 Suppl):I396-401. doi: 10.1161/CIRCULATIONAHA.105.000349.
The influence of an internal mammary artery (IMA) graft on long-term outcomes after percutaneous saphenous vein graft (SVG) intervention is currently unknown.
To examine the impact of IMA on outcomes in patients undergoing SVG interventions, we analyzed 2119 patients from the Duke Cardiovascular Disease Database (1986-2003) with prior coronary artery bypass surgery undergoing cardiac catheterization who had at least 1 SVG graft. Patients were categorized into 4 groups: group I, SVG intervention and patent IMA; group II, no SVG intervention and patent IMA; group III, SVG intervention without patent IMA; and group IV, no SVG intervention without patent IMA. At a median follow-up of 4.8 years (interquartile range, 2.1 to 8.8 years), adjusted survival rates in groups I, II, III, and IV were 72.8%, 72.3%, 64.5%, and 58.9%, respectively. Multivariate Cox proportional hazards modeling showed similar survival for groups I and II (P=0.63) and for groups III and IV (P=0.33). The presence of IMA graft was related to lower long-term mortality (adjusted hazard ratio [HR], 0.69; 95% CI, 0.58 to 0.82), whereas SVG intervention was not associated with long-term mortality (adjusted HR, 0.94; 95% CI, 0.81 to 1.10). In contrast, the adjusted event-free rates for nonfatal myocardial infarction were lower in the SVG intervention groups (groups I and III) than in the non-SVG intervention groups (groups II and IV) (HR for SVG intervention versus no SVG intervention, 3.19; 95% CI, 2.18 to 4.66), with the presence of patent IMA conferring no significant benefit on this outcome (HR, 1.37; 95% CI, 0.91 to 2.08).
In patients undergoing SVG interventions, survival, but not nonfatal myocardial infarction, is favorably influenced by the presence of patent IMA. In contrast, SVG intervention had no measurable survival benefit but was associated with an increased risk of nonfatal myocardial infarction.
目前尚不清楚乳内动脉（IMA）移植对经皮大隐静脉移植血管（SVG）介入术后长期预后的影响。
为研究IMA对接受SVG介入治疗患者预后的影响，我们分析了杜克心血管疾病数据库（1986 - 2003年）中2119例既往接受过冠状动脉旁路移植术且至少有1条SVG移植血管的患者，这些患者接受了心脏导管检查。患者被分为4组：I组，SVG介入且IMA通畅；II组，未进行SVG介入且IMA通畅；III组，SVG介入但IMA不通畅；IV组，未进行SVG介入且IMA不通畅。在中位随访4.8年（四分位间距，2.1至8.8年）时，I、II、III和IV组的校正生存率分别为72.8%、72.3%、64.5%和58.9%。多变量Cox比例风险模型显示，I组和II组（P = 0.63）以及III组和IV组（P = 0.33）的生存率相似。IMA移植血管的存在与较低的长期死亡率相关（校正风险比[HR]，0.69；95%可信区间，0.58至0.82），而SVG介入与长期死亡率无关（校正HR，0.94；95%可信区间，0.81至1.10）。相比之下，SVG介入组（I组和III组）非致命性心肌梗死的校正无事件发生率低于非SVG介入组（II组和IV组）（SVG介入与未进行SVG介入的HR，3.19；95%可信区间，2.18至4.66），IMA通畅对这一结果无显著益处（HR，1.37；95%可信区间，0.91至2.08）。
在接受SVG介入治疗的患者中，IMA通畅对生存率有有利影响，但对非致命性心肌梗死无影响。相比之下，SVG介入无明显的生存益处，但与非致命性心肌梗死风险增加相关。
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