Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA.
Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 70 Francis St, Boston, MA 02115, USA.
Eur Heart J. 2021 Apr 7;42(14):1433-1441. doi: 10.1093/eurheartj/ehab096.
The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients' characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes.
通常认为，冠状动脉搭桥术的通畅性与临床状态之间存在直接关联。然而，这种关系比通常认为的要复杂和多变。关键问题是缺乏对桥血管闭塞的通用定义，以及对接受冠状动脉旁路移植手术患者的标准化影像学检查方案。桥血管的类型、闭塞时间、以及处于危险中的心肌量等因素，以及患者的基线特征，都会影响桥血管通畅性与临床状态之间的关联。现有证据表明，桥血管闭塞与非致命性事件的相关性更高，而非与死亡相关。此外，由于竞争血流导致的桥血管失败通常是良性事件，而在依赖桥血管循环中发生的桥血管闭塞与临床症状相关。在本系统评价中，我们总结了桥血管状态与临床结局之间关联的证据。
