Divisions of Cardiac Surgery and Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (D.U., M.L. M.R.); Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, FL (A.K.); and Department of Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.).
Circulation. 2013 Sep 10;128(11 Suppl 1):S213-8. doi: 10.1161/CIRCULATIONAHA.112.000328.
Intimal hyperplasia of saphenous vein grafts (SVGs) can lead to subsequent graft atherosclerosis and occlusion after coronary artery bypass grafting (CABG). This study examined whether patient characteristics, anatomic factors, and medications are associated with SVG intimal hyperplasia and occlusion after CABG.
We performed a post hoc analysis of the Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) trial, where 322 grafts were assessed by angiography and 90 grafts were examined by intravascular ultrasound at 1 year after CABG. We assessed the following correlates for intimal hyperplasia and occlusion: patient characteristics, discharge medications, target vessel characteristics, and SVG diameter. At 1 year, the SVG mean intimal area was 4.3 ± 2.1 mm(2), and the occlusion rate was 6.2% (13/209). Independent correlates of hyperplasia were larger SVG diameter (1.9 ± 0.2 mm(2)/mm; P<0.001), hypertension (0.7 ± 0.3 mm(2); P=0.03), and grafting to the right coronary territory (0.6 ± 0.3 mm(2); P=0.03), whereas statin (-0.8 ± 0.3 mm(2); P=0.01) and β-blocker use (-1.0 ± 0.4 mm(2); P=0.03) were associated with less hyperplasia. Low target vessel quality was an independent correlate of SVG occlusion (odds ratio, 5.2 ± 3.1; P<0.01).
Hypertension, SVG diameter, grafting to the right coronary artery, and low quality of the target vessel correlate with the development of SVG hyperplasia or occlusion by 1 year after CABG, whereas β-blockers and statins are associated with less SVG disease. These new findings further our understanding of SVG remodeling after bypass surgery and may guide future research to help prevent post-CABG SVG disease.
http://www.clinicaltrials.gov. Unique identifier: NCT00228423.
在冠状动脉旁路移植术（CABG）后，静脉移植物的内膜增生可导致随后的移植物动脉粥样硬化和闭塞。本研究旨在探讨患者特征、解剖因素和药物与 CABG 后静脉移植物内膜增生和闭塞的关系。
我们对 Clopidogrel After Surgery for Coronary Artery Disease（CASCADE）试验进行了事后分析，该试验在 CABG 后 1 年通过血管造影评估了 322 个移植物，通过血管内超声检查了 90 个移植物。我们评估了以下与内膜增生和闭塞相关的因素：患者特征、出院时的药物治疗、靶血管特征和静脉移植物直径。在 1 年时，静脉移植物平均内膜面积为 4.3 ± 2.1 mm²，闭塞率为 6.2%（13/209）。内膜增生的独立相关因素包括静脉移植物直径较大（1.9 ± 0.2 mm²/mm；P<0.001）、高血压（0.7 ± 0.3 mm²；P=0.03）和移植至右冠状动脉区域（0.6 ± 0.3 mm²；P=0.03），而他汀类药物（-0.8 ± 0.3 mm²；P=0.01）和β受体阻滞剂的使用（-1.0 ± 0.4 mm²；P=0.03）与内膜增生减少有关。低靶血管质量是静脉移植物闭塞的独立相关因素（比值比，5.2 ± 3.1；P<0.01）。
高血压、静脉移植物直径、移植至右冠状动脉以及靶血管质量低与 CABG 后 1 年内静脉移植物增生或闭塞相关，而β受体阻滞剂和他汀类药物与静脉移植物疾病较少相关。这些新发现进一步加深了我们对旁路手术后静脉移植物重塑的理解，并可能为预防 CABG 后静脉移植物疾病的未来研究提供指导。
