Zheng Ze, Cheng Zi Chao, Wang Shao Ping, Li Shi Ying, Wang Jian, Peng Hong Yu, Wu Zheng, Li Wen Zheng, Lv Yun, Tian Jia Yu, Cheng Shu Juan, Liu Jing Hua
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Cardiol Res Pract. 2019 Sep 23;2019:6857232. doi: 10.1155/2019/6857232. eCollection 2019.
Chronic total occlusion (CTO) is prevalent in patients with prior coronary artery bypass grafting (CABG). However, data available concerning the prevalence of new-onset CTO of native vessels in patients with prior CABG is limited. Therefore, the objective of the study is to determine predictors for new native-vessel occlusion in patients with prior coronary bypass surgery.
354 patients with prior CABG receiving follow-up angiography are selected and analyzed in the present study, with clinical and angiographic variables being analyzed by logistic regression to determine the predictors of new native-vessel occlusion.
The overall new occlusion rate was 35.59%, with multiple CTOs (42.06%) being the most prevalent (LAD 24.60% and RCA 18.25%, respectively). Additionally, current smoking (OR: 2.67; 95% CI: 2.60 to 2.74; =0.01), reduced ejection fraction (OR: 1.76; 95% CI: 1.04 to 2.97; =0.04), severe stenosis (OR: 3.65; 95% CI: 2.55 to 5.24; =0.01), and diabetes mellitus (OR: 1.86; 95% CI: 1.34 to 2.97; =0.04) serve as the independent predictors for new native-vessel occlusion.
As to high incidence of postoperative CTO, appropriate revascularization strategies and postoperative management should be taken into careful consideration.
慢性完全闭塞(CTO)在既往有冠状动脉旁路移植术(CABG)的患者中很常见。然而,关于既往CABG患者中天然血管新发CTO患病率的现有数据有限。因此,本研究的目的是确定既往冠状动脉搭桥手术患者中新发天然血管闭塞的预测因素。
本研究选取并分析了354例接受随访血管造影的既往CABG患者,通过逻辑回归分析临床和血管造影变量,以确定新发天然血管闭塞的预测因素。
总体新发闭塞率为35.59%,多支CTO(42.06%)最为常见(左前降支分别为24.60%,右冠状动脉为18.25%)。此外,当前吸烟(OR:2.67;95%CI:2.60至2.74;P=0.01)、射血分数降低(OR:1.76;95%CI:1.04至2.97;P=0.04)、严重狭窄(OR:3.65;95%CI:2.55至5.24;P=0.01)和糖尿病(OR:1.86;95%CI:1.34至2.97;P=0.04)是新发天然血管闭塞的独立预测因素。
鉴于术后CTO的高发生率,应仔细考虑适当的血运重建策略和术后管理。