Blachutzik Florian, Achenbach Stephan, Troebs Monique, Roether Jens, Nef Holger, Hamm Christian, Schlundt Christian
Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Cardiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Am J Cardiol. 2016 Aug 15;118(4):473-6. doi: 10.1016/j.amjcard.2016.05.040. Epub 2016 May 28.
Current guidelines recommend invasive coronary angiography and interventional revascularization in ST-elevation and Non-ST-elevation myocardial infarction (STEMI and NSTEMI). The aim of this study was to analyze culprit lesions and percutaneous coronary intervention (PCI) success in patients with previous coronary artery bypass grafting (CABG). We analyzed the data of 121 consecutive patients in whom coronary angiography was performed in the setting of STEMI or NSTEMI and who had previous CABG. Coronary angiograms were reviewed, and clinical data were evaluated. The culprit vessel was identified by means of electrocardiographic findings, echocardiography, and coronary angiography. A bypass graft was the culprit vessel in 86% of patients with STEMI and 68% of patients with NSTEMI. Venous grafts were culprit vessels significantly more frequently than arterial grafts (81 of 260 venous grafts vs 4 of 65 arterial grafts, p <0.001). Attempted acute PCI was successful in 97% of native arteries (31 of 32 patients) but only in 81% of bypass grafts (68 of 84 patients, p = 0.031). Overall in-hospital mortality was 13% (STEMI: 25%, NSTEMI: 10%, p <0.001) and was significantly higher after failed acute PCI (6 of 11 patients; 55%) compared with successful acute PCI (7 of 110 patients; 6%; p = 0.006). In conclusion, the culprit lesion in patients with previous CABG who present with STEMI or NSTEMI is more often located in bypass grafts than in native arteries. Successful PCI is more likely in native arteries compared with bypass grafts.
当前指南推荐对ST段抬高型和非ST段抬高型心肌梗死（STEMI和NSTEMI）患者进行有创冠状动脉造影及介入性血运重建。本研究的目的是分析既往有冠状动脉旁路移植术（CABG）患者的罪犯病变及经皮冠状动脉介入治疗（PCI）成功率。我们分析了121例连续患者的数据，这些患者在STEMI或NSTEMI情况下接受了冠状动脉造影且既往有CABG。回顾冠状动脉造影图像并评估临床数据。通过心电图表现、超声心动图和冠状动脉造影确定罪犯血管。在STEMI患者中，86%的罪犯血管为旁路移植血管，在NSTEMI患者中为68%。静脉移植血管作为罪犯血管的频率显著高于动脉移植血管（260条静脉移植血管中有81条，65条动脉移植血管中有4条，p<0.001）。97%的自身动脉（32例患者中的31例）急性PCI尝试成功，但旁路移植血管仅81%成功（84例患者中的68例，p = 0.031）。总体住院死亡率为13%（STEMI：25%，NSTEMI：10%，p<0.001），急性PCI失败后的死亡率（11例患者中的6例；55%）显著高于急性PCI成功后的死亡率（110例患者中的7例；6%；p = 0.006）。总之，既往有CABG且发生STEMI或NSTEMI的患者，其罪犯病变更常位于旁路移植血管而非自身动脉。与旁路移植血管相比，自身动脉成功进行PCI的可能性更大。
