1 Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
2 Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2018 Jan;210(1):52-57. doi: 10.2214/AJR.17.18186. Epub 2017 Oct 24.
The purpose of this study was to investigate the incidence and natural history of incidentally found and untreated pulmonary embolism (PE) at coronary CT angiography after coronary artery bypass grafting.
We retrospectively reviewed the records of 353 patients consecutively registered between January 1, 2010, and November 11, 2015, who underwent coronary artery bypass grafting followed within 2 weeks by coronary CT angiography. All patients received 100 mg of aspirin and 75 mg of clopidogrel after surgery. We collected relevant clinical and CT data, including total follow-up duration after coronary artery bypass grafting, follow-up CT findings, mortality, and incidence of any recurrent PE.
PE was diagnosed in 22 of the 353 patients (6.2%) who remained in the study after the exclusion criteria were applied. Most of the PEs occurred at the segmental or subsegmental level. All patients were in hemodynamically stable condition, had no symptoms, and underwent follow-up for a median of 53 months (range 19-74 months). Twenty of the 22 patients did not receive anticoagulation, and all but one of these patients had complete resolution of PE at second follow-up coronary CT angiography (median, 149 days after surgery). There was no associated mortality or recurrent PE.
Incidental PE after coronary artery bypass grafting is found in approximately 6% of patients undergoing postoperative coronary CT angiography, and most PEs resolve spontaneously without anticoagulation. No patient in this study died or had recurrent PE during a median follow-up period of 53 months.
本研究旨在探讨冠状动脉旁路移植术后行冠状动脉 CT 血管造影时偶然发现未经治疗的肺栓塞（PE）的发生率和自然史。
我们回顾性分析了 2010 年 1 月 1 日至 2015 年 11 月 11 日期间连续登记的 353 例患者的病历，这些患者均在冠状动脉旁路移植术后 2 周内行冠状动脉 CT 血管造影检查。所有患者术后均接受 100mg 阿司匹林和 75mg 氯吡格雷治疗。我们收集了相关的临床和 CT 数据，包括冠状动脉旁路移植术后的总随访时间、随访 CT 结果、死亡率和任何复发性 PE 的发生率。
在排除标准适用后，353 例患者中有 22 例（6.2%）被诊断为 PE。大多数 PE 发生在节段或亚节段水平。所有患者血流动力学稳定，无任何症状，并接受了中位数为 53 个月（19-74 个月）的随访。22 例患者中，20 例未接受抗凝治疗，除 1 例外，其余患者在第二次随访冠状动脉 CT 血管造影时均完全缓解 PE（中位数为术后 149 天）。无相关死亡或复发性 PE。
冠状动脉旁路移植术后行术后冠状动脉 CT 血管造影时，约 6%的患者偶然发现 PE，大多数 PE 无需抗凝治疗即可自发缓解。在中位随访 53 个月期间，本研究中无患者死亡或发生复发性 PE。
