Hattler Brack, Carr Brendan M, Messenger John, Spertus John, Ebrahimi Ramin, Bishawi Muath, Quin Jacquelyn A, Almassi G Hossein, Collins Joseph F, Kozora Elizabeth, Grover Frederick L, Shroyer A Laurie W
Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.).
University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.).
Circ Cardiovasc Qual Outcomes. 2019 Apr;12(4):e005119. doi: 10.1161/CIRCOUTCOMES.118.005119.
Studies of the relationship between patient self-reported angina symptoms using the Seattle Angina Questionnaire (SAQ) and angiographic findings after coronary artery bypass grafting surgery (CABG) are lacking. Nested within a randomized controlled trial, this prospective observational cohort comparison study aimed to assess which clinical characteristics and angiographic findings are associated with self-reported angina 1 year after CABG.
Patients from the ROOBY trial (Randomized On/Off Bypass) with protocol-specified 1-year post-CABG coronary angiography and SAQ assessments were included (n=1258). Patients reporting no angina (62.3%) within 4 weeks before the 1-year post-CABG study visit on the SAQ angina frequency domain were compared with patients reporting angina (37.7%). Multivariable modeling identified clinical variables and angiographic findings associated with angina. Sequential univariate and multivariable modeling found the following demographic and clinical factors were associated with angina after CABG: younger age, worse preoperative SAQ angina frequency score, smoking, diabetes mellitus, and pre-CABG depression. The only 1-year angiographic finding significantly associated with angina was incomplete revascularization of the left anterior descending (LAD) territory. Graft occlusions, incomplete revascularization of non-LAD territories, and ≥70% lesions in nonrevascularized native coronary arteries were not correlated with the presence or absence of angina. Further, only 30.6% of subjects reporting angina at 1 year had a residual major coronary artery stenosis of ≥70%.
Self-reported angina 1 year after CABG is associated with younger age, worse baseline SAQ angina frequency score, smoking, diabetes mellitus, and depression. The only angiographic finding associated with angina was a poorly revascularized LAD territory. These results may help guide physicians when counseling patients on expected improvements in angina symptoms and in making decisions regarding the need for coronary angiography after CABG. Whether intensive treatment of these comorbidities improves post-CABG angina symptoms requires further study.
URL: https://www.clinicaltrials.gov . Unique identifier: NCT00032630.
目前缺乏关于使用西雅图心绞痛问卷（SAQ）进行患者自我报告的心绞痛症状与冠状动脉旁路移植术（CABG）后血管造影结果之间关系的研究。在一项随机对照试验中，这项前瞻性观察性队列比较研究旨在评估哪些临床特征和血管造影结果与CABG术后1年的自我报告心绞痛相关。
纳入ROOBY试验（随机旁路开/关）中符合方案规定的CABG术后1年冠状动脉造影和SAQ评估的患者（n = 1258）。将在CABG术后1年研究访视前4周内SAQ心绞痛频域中报告无心绞痛的患者（62.3%）与报告有心绞痛的患者（37.7%）进行比较。多变量建模确定了与心绞痛相关的临床变量和血管造影结果。序贯单变量和多变量建模发现以下人口统计学和临床因素与CABG术后心绞痛相关：年龄较小、术前SAQ心绞痛频率评分较差、吸烟、糖尿病和CABG术前抑郁。与心绞痛显著相关的唯一1年血管造影结果是左前降支（LAD）区域的血管再通不完全。移植血管闭塞、非LAD区域的血管再通不完全以及未再血管化的自身冠状动脉中≥70%的病变与心绞痛的有无无关。此外，在1年时报告有心绞痛的受试者中，只有30.6%存在≥70%的残余主要冠状动脉狭窄。
CABG术后1年的自我报告心绞痛与年龄较小、基线SAQ心绞痛频率评分较差、吸烟、糖尿病和抑郁相关。与心绞痛相关的唯一血管造影结果是LAD区域血管再通不良。这些结果可能有助于指导医生在向患者咨询心绞痛症状的预期改善情况以及在做出关于CABG术后冠状动脉造影必要性的决策时提供参考。这些合并症的强化治疗是否能改善CABG术后心绞痛症状需要进一步研究。
网址：https://www.clinicaltrials.gov 。唯一标识符：NCT00032630。
