San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121 USA.
J Invasive Cardiol. 2020 Jun;32(6):E143-E150. doi: 10.25270/jic/19.00486.
Limited studies of percutaneous coronary intervention (PCI) of the left internal mammary artery (LIMA) graft exist. We compared outcomes of different bypass grafts to the left anterior descending (LAD) coronary artery.
Participants ≥65 years old in the CathPCI Registry who underwent PCI of a bypass graft to the LAD between 2009 and 2014 were included. Individuals were divided by graft type: LIMA; saphenous vein graft (SVG); or other. Clinical characteristics and outcomes using Medicare claims data for mortality, rehospitalization for myocardial infarction (MI), stroke, or unplanned repeat revascularization at 1 year were examined.
There were 10,051 PCIs performed on grafts to the LAD: 6797 SVGs (67.6%), 3011 LIMA grafts (30.0%); and 243 other (2.4%). Procedural success rates (SVG 92.9%, LIMA 91.1%, other 93.4%; P=.65) and in-patient mortality rates (SVG 3.0%, LIMA 2.7%, other 2.1%; P=.61) were similar. However, dissection rates were higher in LIMA interventions (SVG 0.7%, LIMA 2.8%, other 2.5%; P<.001). At 1 year, mortality, MI, and repeat revascularization were lower in arterial grafts (mortality: SVG 16.6%, LIMA 14.8%, other 11.8% [P<.001]; MI: SVG 9.9%, LIMA, 6.6%, other 8.1% [P<.001]; revascularization: SVG 14.4%, LIMA 9.5%, other 10.4% [P<.001]). After multivariable adjustment, LIMA patients had lower rates of MI (hazard ratio, 0.71; 95% confidence interval, 0.60-0.84) and repeat revascularization (hazard ratio, 0.68; 95% confidence interval, 0.59-0.79) compared with the SVG group. Mortality was not significantly different.
Despite similar procedural success rates compared with SVG and other graft types, LIMA interventions were independently associated with lower rates of recurrent MI and repeat revascularization at 1 year.
目前关于经皮冠状动脉介入治疗（PCI）左内乳动脉（LIMA）桥接的研究较少。我们比较了不同旁路移植物至前降支（LAD）的结果。
纳入 2009 年至 2014 年间接受 LAD 旁路移植术的 CathPCI 注册研究中年龄≥65 岁的患者。根据移植物类型将个体分为：LIMA；隐静脉移植物（SVG）；或其他。使用医疗保险索赔数据检查 1 年内死亡率、因心肌梗死（MI）、中风或计划外再次血运重建而再次住院的临床特征和结果。
共对 10051 例 LAD 桥接的 PCI 进行了分析：SVG 6797 例（67.6%）、LIMA 3011 例（30.0%）和其他 243 例（2.4%）。程序成功率（SVG 92.9%、LIMA 91.1%、其他 93.4%；P=.65）和住院死亡率（SVG 3.0%、LIMA 2.7%、其他 2.1%；P=.61）相似。然而，LIMA 介入的夹层发生率更高（SVG 0.7%、LIMA 2.8%、其他 2.5%；P<.001）。1 年时，动脉移植物的死亡率、MI 和再次血运重建率较低（死亡率：SVG 16.6%、LIMA 14.8%、其他 11.8%[P<.001]；MI：SVG 9.9%、LIMA 6.6%、其他 8.1%[P<.001]；血运重建：SVG 14.4%、LIMA 9.5%、其他 10.4%[P<.001]）。多变量调整后，与 SVG 组相比，LIMA 患者的 MI（风险比，0.71；95%置信区间，0.60-0.84）和再次血运重建（风险比，0.68；95%置信区间，0.59-0.79）发生率较低。死亡率无显著差异。
尽管与 SVG 和其他移植物类型相比，手术成功率相似，但 LIMA 干预与 1 年内复发性 MI 和再次血运重建的发生率较低独立相关。
