Cardiothoracic Services, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom.
Catheter Cardiovasc Interv. 2011 Aug 1;78(2):169-76. doi: 10.1002/ccd.22841. Epub 2011 Mar 16.
Limited data is available to guide operators as to the optimal revascularisation strategy in patients with previous CABG representing with angina.
Retrospective analysis of 161 patients with prior CABG undergoing PCI in two centres between September 2005 and April 2008.
161 patients (132 male, 68 ± 8 years) underwent PCI at 126 ± 65 months after index CABG. Clinical presentation of recurrent ischaemia was stable in 59.7% and as an acute coronary syndrome in 40.3% of patients. Mean follow-up after PCI was 13.5 ± 4.8 months. About 62.7% of patients underwent native vessel PCI, 32.9% had a graft only PCI, and 4.4% having a combination of both. Drug eluting stents were used in 84.9% of cases. There was one cardiac death and one case of redo CABG during follow-up. Mean CCS angina class decreased from 2.87 to 0.67 (P < 0.0001) in the follow-up group. About 13.6 % of all patients had a MACE at follow up. This was higher in the graft PCI group (21.6% vs. 8.9%, P = 0.048). About 12.4% of the total cohort underwent repeat PCI although 30% of these required PCI for a de-novo lesion. TVR rate was significantly higher in patients undergoing graft PCI than native vessel PCI (15% vs. 4.9%, P = 0.031). Graft PCI was an independent predictor (HR 3.73, 1.27-10.87 [95%CI], P = 0.016) of MACE in these patients.
PCI significantly improved angina in these patients with low overall rates of TVR. However TVR rate was significantly higher in patients undergoing graft PCI than those undergoing native vessel PCI.
在先前接受过冠状动脉旁路移植术（CABG）并出现心绞痛的患者中，关于最佳血运重建策略的指导数据有限。
对 2005 年 9 月至 2008 年 4 月期间在两个中心接受 PCI 的 161 例先前接受过 CABG 的患者进行回顾性分析。
161 例患者（132 例男性，68±8 岁）在 CABG 后 126±65 个月行 PCI。复发性缺血的临床表现稳定的患者占 59.7%，急性冠状动脉综合征患者占 40.3%。PCI 后平均随访 13.5±4.8 个月。约 62.7%的患者行原血管 PCI，32.9%仅行桥血管 PCI，4.4%两者均行。84.9%的病例使用药物洗脱支架。随访期间发生心脏死亡 1 例，再次 CABG 1 例。随访组的 CCS 心绞痛分级从 2.87 降至 0.67（P<0.0001）。随访时约 13.6%的患者发生主要不良心血管事件（MACE）。桥血管 PCI 组的发生率（21.6%）高于仅原血管 PCI 组（8.9%）（P=0.048）。虽然总队列中有 30%的患者因新发病变而需要 PCI，但仍有 12.4%的患者行重复 PCI。行桥血管 PCI 的患者的 TVR 发生率显著高于行原血管 PCI 的患者（15% vs. 4.9%，P=0.031）。桥血管 PCI 是这些患者发生 MACE 的独立预测因素（HR 3.73，1.27-10.87[95%CI]，P=0.016）。
这些患者行 PCI 后心绞痛显著改善，TVR 的总体发生率较低。然而，行桥血管 PCI 的患者的 TVR 发生率明显高于行原血管 PCI 的患者。
