Zając Piotr, Życiński Paweł, Qawoq Haval, Jankowski Łukasz, Peruga Jan, Wcisło Tomasz, Pagórek Piotr, Peruga Jan Z, Kasprzak Jarosław D, Plewka Michał
1Department and Chair of Cardiology, Medical University of Lodz, Lodz, Poland.
Kardiol Pol. 2016;74(4):322-30. doi: 10.5603/KP.a2015.0199. Epub 2015 Sep 28.
Patients after previous coronary artery bypass grafting (CABG) often require repeat percutaneous revascularisation due to poor patency rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data are available to evaluate different percutaneous revascularisation strategies in patients after previous CABG.
To evaluate outcomes of percutaneous coronary intervention (PCI) in patients after previous CABG, including the effect of treatment on the quality of life and symptoms, and secondly to assess the relation between angiographic factors and treatment outcomes
This was a prospective observational study which included 78 patients after previous CABG. Following coronary angiography, the patients were assigned to one of three groups: group A (n = 20), PCI of a SVG (PCI SVG); group B (n = 29), PCI of a native coronary artery (PCI NA); group C (n = 29), control group that received medical treatment (MT) only. Duration of follow-up was 12 months.
Compared to MT patients, patients treated with PCI had significantly higher Canadian Cardiovascular Society (CCS) class (2.75 vs. 2.41, p = 0.03) and more frequently had coronary angiography performed due to unstable angina (57% vs. 31%, p = 0.04). Patients in the PCI SVG group had significantly older SVG conduits compared to the PCI NA group (13.4 years vs. 8.2 years, p = 0.005). At 12 months of follow-up, we found a significant improvement in the EQ-5D index of the quality of life, and a significant reduction in CCS class in the PCI SVG group (0.66 vs. 0.7, p = 0.0003, and 2.75 vs. 1.9, p < 0.001, respectively) and in the PCI NA group (0.65 vs. 0.72, p < 0.001, and 2.75 vs. 2.17, p < 0.001, respectively), but no improvement in the MT group. Treatment outcomes did not differ significantly between the three groups (combined endpoint rate 20% vs. 13% vs. 27.5%, p = 0.37). In multivariate analysis, SVG age > 11 years was identified as a significant predictor of poor outcomes in patients treated with PCI after previous CABG.
PCI in patients after previous CABG does not improve prognosis but significantly improves the quality of life and reduces symptom severity.
既往接受冠状动脉旁路移植术（CABG）的患者，由于大隐静脉移植血管（SVG）通畅率低以及再次行CABG风险较高，常需要再次进行经皮血管重建术。目前几乎没有数据可用于评估既往CABG术后患者不同的经皮血管重建策略。
评估既往CABG术后患者经皮冠状动脉介入治疗（PCI）的结果，包括治疗对生活质量和症状的影响，其次评估血管造影因素与治疗结果之间的关系。
这是一项前瞻性观察性研究，纳入78例既往接受CABG的患者。冠状动脉造影后，患者被分为三组之一：A组（n = 20），SVG的PCI（PCI SVG）；B组（n = 29），自身冠状动脉的PCI（PCI NA）；C组（n = 29），仅接受药物治疗（MT）的对照组。随访时间为12个月。
与MT患者相比，接受PCI治疗的患者加拿大心血管学会（CCS）分级显著更高（2.75对2.41，p = 0.03），且因不稳定型心绞痛进行冠状动脉造影的频率更高（57%对31%，p = 0.04）。与PCI NA组相比，PCI SVG组的SVG血管年龄显著更大（13.4岁对8.2岁，p = 0.005）。在随访12个月时，我们发现PCI SVG组（分别为0.66对0.7，p = 0.0003，以及2.75对1.9，p < 0.001）和PCI NA组（分别为0.65对0.72，p < 0.001，以及2.75对2.17，p < 0.001）的生活质量EQ - 5D指数有显著改善，CCS分级显著降低，但MT组无改善。三组之间的治疗结果无显著差异（联合终点发生率20%对13%对27.5%，p = 0.37）。多变量分析中，SVG年龄> 11岁被确定为既往CABG术后接受PCI治疗患者预后不良的显著预测因素。
既往CABG术后患者的PCI不能改善预后，但能显著改善生活质量并减轻症状严重程度。
