Abdulmalik Ameen, Arabi Abdulrahman, Alroaini Abdulwahhab, Rosman Howard, Lalonde Thomas
Department of Cardiology, St. John Hospital & Medical Center, Detroit, Michigan 48236, USA.
J Interv Cardiol. 2007 Jun;20(3):204-8. doi: 10.1111/j.1540-8183.2007.00258.x.
With continuing technical advances in percutaneous coronary interventions (PCI) for coronary artery disease (CAD), patients undergoing coronary artery bypass surgery (CABG) often have complex coronary anatomy that is not ideal for PCI. Because of the complex anatomy, these patients have a higher risk of early graft occlusion. The feasibility of PCI in the treatment of early graft occlusion is not well established.
A retrospective chart review was performed of patients presenting with recurrent ischemia within three months post-CABG and at one-year follow-up.
Forty-six patients with 156 grafts were identified. Three presented with STEMI, 21 with NSTEMI, 21 with unstable angina, and one with congestive heart failure. Sixty-three grafts were occluded or stenosed (>70%). Twenty-seven grafts (43%) in 17 patients were not amenable to PCI. The other 34 grafts (54%) in 23 patients underwent successful PCI. PCI was performed upon native vessels and occluded grafts with equal frequency. Six patients had patent grafts. At one-year follow-up, six of 23 patients in the PCI group were readmitted with ischemia; five vessels (14%) in four patients had restenosed. There were no deaths. In the group with no PCI, 11 of 23 patients were readmitted with ischemia with one death.
PCI for early post-CABG occlusion was safely performed in slightly more than half of target vessels. PCI was performed upon native vessels and occluded grafts with equal frequency. After initial PCI success, the clinical target vessel restenosis rate was 14% at one-year follow-up.
随着冠心病经皮冠状动脉介入治疗（PCI）技术的不断进步，接受冠状动脉旁路移植术（CABG）的患者常伴有复杂的冠状动脉解剖结构，这对于PCI而言并不理想。由于解剖结构复杂，这些患者早期移植血管闭塞的风险更高。PCI治疗早期移植血管闭塞的可行性尚未明确。
对CABG术后3个月内出现复发性缺血且进行了1年随访的患者进行回顾性病历审查。
共确定了46例患者，有156条移植血管。3例表现为ST段抬高型心肌梗死（STEMI），21例为非ST段抬高型心肌梗死（NSTEMI），21例为不稳定型心绞痛，1例为充血性心力衰竭。63条移植血管闭塞或狭窄（>70%）。17例患者的27条移植血管（43%）不适合进行PCI。23例患者的另外34条移植血管（54%）成功接受了PCI。对自身血管和闭塞的移植血管进行PCI的频率相同。6例患者的移植血管通畅。在1年随访时，PCI组的23例患者中有6例因缺血再次入院；4例患者的5条血管（14%）发生了再狭窄。无死亡病例。在未进行PCI的组中，23例患者中有11例因缺血再次入院，1例死亡。
对于CABG术后早期闭塞，略超过半数的靶血管成功安全地进行了PCI。对自身血管和闭塞的移植血管进行PCI的频率相同。初次PCI成功后，1年随访时临床靶血管再狭窄率为14%。
