Weintraub W S, Cohen C L, Curling P E, Jones E L, Craver J M, Guyton R, King S B, Douglas J S
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
J Am Coll Cardiol. 1990 Nov;16(6):1341-7. doi: 10.1016/0735-1097(90)90374-x.
The results of coronary artery bypass surgery after failed elective coronary angioplasty in patients who have undergone prior coronary surgery are unknown. Coronary angioplasty may be performed to relieve angina after surgery either to the native coronary vessels or to grafts. Failure of attempted coronary angioplasty may mandate repeat coronary surgery, often in the setting of acute ischemia. From 1980 to 1989, 1,263 patients with prior coronary bypass surgery underwent angioplasty; of these patients, 46 (3.6%) underwent reoperation for failed angioplasty during the same hospital stay. Of the 46 patients who underwent reoperation, 33 had and 13 did not have acute ischemia. In the group with ischemia, 3 patients (9.1%) died and 14 (42.4%) died or had a Q wave myocardial infarction in the hospital compared with no deaths (p = NS) and no deaths or Q wave myocardial infarction (p = 0.005) in the group without ischemia. At 3 years, the actuarial survival rate was 88 +/- 6% in the group with ischemia, whereas there were no deaths in the group without ischemia (p = NS), and freedom from death or myocardial infarction was 51 +/- 10% in the group with ischemia, versus no events in the group without ischemia (p = 0.006). In most patients with prior coronary bypass surgery, coronary angioplasty was performed without the need for repeat coronary bypass surgery. Should coronary angioplasty fail, reoperation in patients without acute ischemia can be performed with overall patient survival comparable to that of elective reoperative coronary bypass without coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
对于之前接受过冠状动脉手术的患者，选择性冠状动脉血管成形术失败后进行冠状动脉搭桥手术的结果尚不清楚。冠状动脉血管成形术可用于缓解手术后原发性冠状动脉血管或移植血管的心绞痛。尝试性冠状动脉血管成形术失败可能需要再次进行冠状动脉手术，通常是在急性缺血的情况下。1980年至1989年，1263例之前接受过冠状动脉搭桥手术的患者接受了血管成形术；其中，46例（3.6%）在同一住院期间因血管成形术失败而接受了再次手术。在接受再次手术的46例患者中，33例有急性缺血，13例没有急性缺血。在有缺血的组中，3例（9.1%）死亡，14例（42.4%）在医院死亡或发生Q波心肌梗死，而无缺血组无死亡（p=无显著差异），也无死亡或Q波心肌梗死（p=0.005）。3年时，有缺血组的精算生存率为88±6%，而无缺血组无死亡（p=无显著差异），有缺血组无死亡或心肌梗死的生存率为51±10%，无缺血组无事件发生（p=0.006）。在大多数之前接受过冠状动脉搭桥手术的患者中，进行冠状动脉血管成形术无需再次进行冠状动脉搭桥手术。如果冠状动脉血管成形术失败，对于没有急性缺血的患者进行再次手术，其总体患者生存率与未进行冠状动脉血管成形术的选择性再次手术冠状动脉搭桥相当。（摘要截短至250字）
