体外循环冠状动脉旁路手术后的术前 SYNTAX 评分和移植物通畅率。

Preoperative SYNTAX score and graft patency after off-pump coronary bypass surgery.

机构信息

Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan.

出版信息

Eur J Cardiothorac Surg. 2013 Jul;44(1):e25-31. doi: 10.1093/ejcts/ezt156. Epub 2013 May 3.

DOI:10.1093/ejcts/ezt156

PMID:23644701

Abstract

OBJECTIVES

We examined the association between the preoperative SYNTAX score and graft patency after off-pump coronary artery bypass surgery (CABG).

METHODS

Of 912 consecutive patients undergoing isolated CABG (906 by the off-pump technique) between 2002 and 2011, 217 underwent computed tomography (CT) angiography. From this cohort, we studied 189 patients for whom preoperative SYNTAX scores were retrospectively obtained. The primary endpoint was at least one graft occlusion on the follow-up CT angiography. Graft occlusion was defined as the absence of contrast agent along the course of the graft. In sequential grafts, each segment was analysed as a separate graft. The secondary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE), which was defined as cerebrovascular accident, non-fatal myocardial infarction, admission due to pump failure and repeated revascularization. All arterial conduits were harvested with the skeletonization technique and used as in-situ grafts except one right-side internal thoracic artery (ITA).

RESULTS

The mean interval from operation to angiogram was 4.7 ± 2.4 years, range 0.8-10.0 years. Estimated 8-year graft patencies of ITA- left anterior descending artery, ITA-circumflex branch (CX), saphenous vein -CX and/or posterior descending artery (PDA), and gastroepiploic artery -PDA were 97.4 ± 1.5, 89.3 ± 4.2, 86.5 ± 6.7, and 86.2 ± 5.7%, respectively. Of the 666 total distal anastomoses, 27 in 21 patients were occluded. No significant difference was found in the preoperative SYNTAX scores between the 21 patients with at least one graft occlusion (mean 35.7; range 15.0-51.5) and the 168 patients without graft occlusion (mean 36.6; range 17.0-54.5) (unpaired t-test, P = 0.87). In univariate and multivariate logistic regression models, no significant association was found between at least one graft occlusion and individual components of the SYNTAX score. There was no significant difference in patients with low (≤ 22), intermediate (23-32) and high (≥ 33) SYNTAX scores in the cumulative rates of at least one graft occlusion (log-rank test, P = 0.88) and MACCE (log-rank test, P = 0.86).

CONCLUSIONS

The preoperative SYNTAX score and its individual components are not associated with graft occlusion after off-pump CABG.

摘要

目的

研究非体外循环冠状动脉旁路移植术（CABG）前 SYNTAX 评分与移植通畅性之间的关系。

方法

在 2002 年至 2011 年间，连续 912 例接受单纯 CABG（906 例采用非体外循环技术）的患者中，有 217 例行计算机断层扫描（CT）血管造影术。从这一组患者中，我们研究了 189 例回顾性获得术前 SYNTAX 评分的患者。主要终点是在随访 CT 血管造影上至少有一个移植物闭塞。移植物闭塞定义为移植物走行中无造影剂。在序贯移植物中，每个节段均作为单独的移植物进行分析。次要终点是主要不良心脏和脑血管事件（MACCE）的复合终点，定义为脑血管意外、非致命性心肌梗死、因泵衰竭而入院和再次血运重建。所有动脉移植物均采用骨骼化技术采集并用作原位移植物，除 1 根右侧内乳动脉（ITA）外。

结果

从手术到造影的平均间隔时间为 4.7±2.4 年，范围为 0.8-10.0 年。ITA-前降支、ITA-回旋支（CX）、大隐静脉-CX 和/或后降支（PDA）和胃网膜动脉-PDA 的估计 8 年通畅率分别为 97.4±1.5%、89.3±4.2%、86.5±6.7%和 86.2±5.7%。在 666 个远端吻合中，21 例患者中有 27 个吻合口闭塞。在至少有一个移植物闭塞的 21 例患者（平均 35.7；范围 15.0-51.5）与没有移植物闭塞的 168 例患者（平均 36.6；范围 17.0-54.5）之间，术前 SYNTAX 评分无显著差异（未配对 t 检验，P=0.87）。在单变量和多变量逻辑回归模型中，至少有一个移植物闭塞与 SYNTAX 评分的各个成分之间无显著关联。低（≤22）、中（23-32）和高（≥33）SYNTAX 评分患者的至少一个移植物闭塞累积率（对数秩检验，P=0.88）和 MACCE（对数秩检验，P=0.86）无显著差异。