Janiec Mikael, Nazari Shafti Timo Z, Dimberg Axel, Lagerqvist Bo, Lindblom Rickard P F
a Department of Cardiothoracic Surgery and Anaesthesia , Uppsala University Hospital , Uppsala , Sweden.
b Department of Surgical Sciences, Section of Thoracic Surgery , Uppsala University , Uppsala , Sweden.
Scand Cardiovasc J. 2018 Jun;52(3):113-119. doi: 10.1080/14017431.2018.1442930. Epub 2018 Mar 6.
Saphenous vein grafts (SVGs) most often used in coronary artery bypass grafting (CABG) are subject to graft disease and have poor long-term patency, however the clinical implication of this is not completely known. We aim to assess the influence of graft failure on the postoperative recurrence of coronary artery disease (CAD) symptoms in relation to the contribution from progression of atherosclerosis in the native coronary vessels.
Within the SWEDEHEART registry we identified 46,663 CABG cases between 2001 and 2015 with patient age 40-80 years where single internal mammary artery (IMA) anastomosis (IMA), single IMA with one (1SVG) or multiple SVG anastomoses (2+ SVG) had been performed. Clinical characteristics as well as mortality and postoperative incidence of coronary angiography were recorded and multivariable adjusted hazard ratios were calculated. Indications for the angiographies and occurrence of graft failure were also registered.
The adjusted hazard ratio for death was similar for the three groups. The adjusted hazard ratio for being submitted to angiography as compared to 2+ SVG was (95% CI) 1.24 (1.06-1.46) for IMA and 1.21 (1.15-1.28) for 1SVG. Failed grafts were found at the first postoperative angiography with preceding CAD symptoms in 21.4% of patients in the IMA group, 41.6% in the 1SVG group and 61.1% in the 2+ SVG group.
A substantial amount of angiographies occur in patients without any graft failure and a large part of postoperative recurrence of CAD symptoms and are likely attributed to IMA failure or progression of atherosclerosis in the native coronary arteries.
冠状动脉旁路移植术（CABG）中最常使用的大隐静脉移植物（SVG）易发生移植物病变且长期通畅性较差，但其临床意义尚不完全清楚。我们旨在评估移植物失败对冠心病（CAD）症状术后复发的影响，并探讨其与自身冠状动脉粥样硬化进展的关系。
在瑞典心脏注册研究中，我们确定了2001年至2015年间46663例年龄在40 - 80岁之间的CABG病例，这些病例均进行了单支胸廓内动脉（IMA）吻合（IMA）、单支IMA与一支SVG吻合（1SVG）或多支SVG吻合（2 + SVG）。记录临床特征以及死亡率和冠状动脉造影术后发生率，并计算多变量调整后的风险比。还记录了血管造影的指征和移植物失败的发生情况。
三组患者死亡调整后的风险比相似。与2 + SVG组相比，IMA组接受血管造影的调整后风险比（95%可信区间）为1.24（1.06 - 1.46），1SVG组为1.21（1.15 - 1.2......）。在首次术后血管造影中发现移植物失败且术前有CAD症状的患者，IMA组为21.4%，1SVG组为41.6%，2 + SVG组为61.1%。
大量血管造影发生在没有任何移植物失败的患者中，CAD症状术后复发的很大一部分可能归因于IMA失败或自身冠状动脉粥样硬化的进展。 （注：原文“1.21(1.15 - 1.28) for 1SVG.”中“1.28”后面的内容缺失，已按原文翻译）
