Han Youngjin, Choo Suk Jung, Kwon Hyunwook, Lee Jae Won, Chung Cheol Hyun, Kim Hyangkyoung, Kwon Tae-Won, Cho Yong-Pil
Department of and Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
Department of Thoracic Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
PLoS One. 2017 Sep 5;12(9):e0184168. doi: 10.1371/journal.pone.0184168. eCollection 2017.
The present study was conducted to investigate whether upper-extremity vascular access (VA) creation increases the risk for major adverse cardiac events (MACE) and death in patients undergoing coronary artery bypass grafting (CABG) with an in situ left internal thoracic artery (ITA) graft. A total of 111 patients with CABG with a left ITA graft who underwent upper-extremity VA creation were analyzed retrospectively; 93 patients received left VA creation (83.8%, ipsilateral group) and 18 patients received right VA creation (16.2%, contralateral group). The primary outcome was the occurrence of MACE, and the secondary outcome was the composite of MACE or late death. There were no significant differences in the incidence of primary (P = 0.30) or secondary (P = 0.09) outcomes between the two groups. Multivariate regression analysis indicated that prior cerebrovascular accidents (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.37-7.97; P = 0.01) and type of VA (HR 3.44; 95% CI 1.34-8.82; P = 0.01) were independently associated with MACE; prior peripheral arterial occlusive disease (HR 4.22; 95% CI 1.62-10.98; P<0.01) and type of VA (arteriovenous fistula vs. prosthetic arteriovenous grafting) (HR 3.06; 95% CI, 1.42-6.61; P<0.01) were associated with the composite of MACE or death. The side and location of VA were not associated with MACE or death. Our study showed no definite evidence that ipsilateral VA creation affects the subsequent occurrence of MACE or late death from any cause. The type of VA (a prosthetic arteriovenous grafting) is a significant predictor of the subsequent occurrence of MACE or late death.
本研究旨在调查上肢血管通路（VA）建立是否会增加接受原位左胸廓内动脉（ITA）移植的冠状动脉旁路移植术（CABG）患者发生主要不良心脏事件（MACE）和死亡的风险。对111例行CABG并接受左ITA移植且接受上肢VA建立的患者进行回顾性分析；93例患者接受左VA建立（83.8%，同侧组），18例患者接受右VA建立（16.2%，对侧组）。主要结局是MACE的发生，次要结局是MACE或晚期死亡的复合情况。两组之间主要结局（P = 0.30）或次要结局（P = 0.09）的发生率无显著差异。多因素回归分析表明，既往脑血管意外（风险比[HR] 3.30；95%置信区间[CI] 1.37 - 7.97；P = 0.01）和VA类型（HR 3.44；95% CI 1.34 - 8.82；P = 0.01）与MACE独立相关；既往外周动脉闭塞性疾病（HR 4.22；95% CI 1.62 - 10.98；P<0.01）和VA类型（动静脉内瘘与人工动静脉移植）（HR 3.06；95% CI，1.42 - 6.61；P<0.01）与MACE或死亡的复合情况相关。VA的侧别和位置与MACE或死亡无关。我们的研究没有明确证据表明同侧VA建立会影响随后MACE的发生或任何原因导致的晚期死亡。VA类型（人工动静脉移植）是随后发生MACE或晚期死亡的重要预测因素。
