Januszek Rafał, Siudak Zbigniew, Dziewierz Artur, Rakowski Tomasz, Dudek Dariusz, Bartuś Stanisław
Department of Clinical Rehabilitation, University of Physical Education, Krakow, Poland.
Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.
Arch Med Sci. 2019 Jan 30;17(3):628-637. doi: 10.5114/aoms.2018.75608. eCollection 2021.
The long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses.
We enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery bypass grafting (CABG) and death. The mean follow-up was 964 ±799.1 days and was completed among 156 patients. Multivariate analysis was used to assess determinants of study endpoints during follow-up. Moreover, we compared survival curves according to the type of PCI and presence of anti-embolic protection.
The primary endpoint of the study occurred in 59.7% of patients after the mean time of 669.6 ±598.7 days. The TVR occurred in 37.9% of individuals, TLR in 24.2%, MI in 26.3%, stroke in 4.2%, CABG in 2.1% and death in 30.5% of patients. In Cox multivariate analysis, PCI of two or more bypasses ( < 0.01), post-dilatation ( < 0.05) and no-reflow ( < 0.05) were the independent determinants of the primary study endpoint. No significant impact of anti-embolic protection devices on long-term outcomes was observed.
Percutaneous coronary interventions of two or more bypasses, post-dilatation and no-reflow are predictors of worse outcome in patients undergoing PCI within coronary artery bypass grafts.
与在原生冠状动脉内进行经皮冠状动脉介入治疗（PCI）相比，在冠状动脉旁路移植术中进行PCI的长期预后仍然较差。因此，我们旨在评估冠状动脉旁路移植术PCI术后长期临床预后的预测因素。
我们纳入了194例接受冠状动脉旁路移植术PCI术后的患者，平均年龄为69.5±8.3岁（男性占73.2%）。主要研究终点是靶血管血运重建（TVR）、靶病变血运重建（TLR）、心肌梗死（MI）、中风、冠状动脉旁路移植术（CABG）和死亡的综合情况。平均随访时间为964±799.1天，156例患者完成了随访。采用多变量分析评估随访期间研究终点的决定因素。此外，我们根据PCI类型和抗栓保护装置的使用情况比较了生存曲线。
研究的主要终点在平均669.6±598.7天之后出现在59.7%的患者中。TVR发生在37.9%的个体中，TLR发生在24.2%，MI发生在26.3%，中风发生在4.2%，CABG发生在2.1%，死亡发生在30.5%的患者中。在Cox多变量分析中，两条或更多旁路的PCI（<0.01）、后扩张（<0.05）和无复流（<0.05）是主要研究终点的独立决定因素。未观察到抗栓保护装置对长期预后有显著影响。
两条或更多旁路的经皮冠状动脉介入治疗、后扩张和无复流是冠状动脉旁路移植术内行PCI患者预后较差的预测因素。
