Department of Cardiology, Beijing An-Zhen Hospital, Capital Medical University, Beijing 100029, China ; Department of Cardiology, Beijing Ji-Shui-Tan Hospital, the 4th Clinical College of Peking University Health Science Center, Beijing 100035, China.
Department of Cardiology, Beijing An-Zhen Hospital, Capital Medical University, Beijing 100029, China.
J Geriatr Cardiol. 2014 Mar;11(1):26-31. doi: 10.3969/j.issn.1671-5411.2014.01.010.
To investigate the procedure characteristics and long term follow-up of percutaneous coronary intervention (PCI) for saphaneous vein graft (SVG) lesions in the elderly patients.
From December 2005 to December 2011, 84 graft lesions were treated percutaneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Primary endpoint was defined as major adverse cardiovascular events (MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction).
The graft age was 6.7 ± 4.0 years. Most anastomosis lesions (80.0%) presented within one year post coronary artery bypass grafting (CABG). Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions (70.6% vs. 91.7%, 79.0%, P < 0.05). The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI (29.2%, P < 0.01). The diameter of the stent was smallest in distal anastomosis group (2.9 ± 0.4 mm, P < 0.05). The highest post dilatation pressure was required in the proximal anastomosis (17.8 ± 2.7 atm, P < 0.05). The patients were followed up for 24.3 ± 16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI (47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P < 0.05). Old myocardial infarction was the predictive factor for the poor clinical outcomes (P = 0.04).
PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.
研究经皮冠状动脉介入治疗（PCI）老年患者大隐静脉移植物（SVG）病变的手术特点和长期随访结果。
2005 年 12 月至 2011 年 12 月，共对 84 处移植物病变进行了经皮治疗。近端吻合口病变 17 处，SVG 体部病变 48 处，远端吻合口病变 19 处。主要终点定义为主要不良心血管事件（MACE，包括心源性死亡、靶血管血运重建、急性心肌梗死）。
移植物年龄为 6.7 ± 4.0 年。大多数吻合口病变（80.0%）发生在冠状动脉旁路移植术后 1 年内。与 SVG 体部和远端吻合口病变相比，近端吻合口病变 PCI 的成功率最低（70.6% vs. 91.7%、79.0%，P < 0.05）。19.1%的患者使用了远端栓塞保护装置，最常用于 SVG 体部 PCI（29.2%，P < 0.01）。远端吻合口组支架直径最小（2.9 ± 0.4mm，P < 0.05）。近端吻合口需要的后扩张压力最高（17.8 ± 2.7atm，P < 0.05）。患者平均随访 24.3 ± 16.9 个月。18.57%的患者发生 MACE。近端吻合口 PCI 的 MACE 发生率最高（47.1% vs. SVG 体部 PCI 16.7%、远端吻合口 PCI 21.1%，P < 0.05）。陈旧性心肌梗死是临床预后不良的预测因素（P = 0.04）。
SVG 病变 PCI 是可行的，但成功率较低。与 SVG 体部和远端吻合口病变相比，吻合口病变 PCI 的成功率最低，MACE 发生率最高。陈旧性心肌梗死是预后不良的预测因素。
