旁路移植术与原生冠状动脉疾病活动。
Bypass Grafting and Native Coronary Artery Disease Activity.
机构信息
Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA; BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
出版信息
JACC Cardiovasc Imaging. 2022 May;15(5):875-887. doi: 10.1016/j.jcmg.2021.11.030. Epub 2022 Feb 16.
OBJECTIVES
The aim of this study was to describe the potential of F-sodium fluoride (F-NaF) positron emission tomography (PET) to identify graft vasculopathy and to investigate the influence of coronary artery bypass graft (CABG) surgery on native coronary artery disease activity and progression.
BACKGROUND
As well as developing graft vasculopathy, CABGs have been proposed to accelerate native coronary atherosclerosis.
METHODS
Patients with established coronary artery disease underwent baseline F-NaF PET, coronary artery calcium scoring, coronary computed tomographic angiography, and 1-year repeat coronary artery calcium scoring. Whole-vessel coronary microcalcification activity (CMA) on F-NaF PET and change in calcium scores were quantified in patients with and without CABG surgery.
RESULTS
Among 293 participants (mean age 65 ± 9 years, 84% men), 48 (16%) underwent CABG surgery 2.7 years [IQR: 1.4-10.4 years] previously. Although all arterial and the majority (120 of 128 [94%]) of vein grafts showed no F-NaF uptake, 8 saphenous vein grafts in 7 subjects had detectable CMA. Bypassed native coronary arteries had 3 times higher CMA values (2.1 [IQR: 0.4-7.5] vs 0.6 [IQR: 0-2.7]; P < 0.001) and greater progression of 1-year calcium scores (118 Agatston unit [IQR: 48-194 Agatston unit] vs 69 [IQR: 21-142 Agatston unit]; P = 0.01) compared with patients who had not undergone CABG, an effect confined largely to native coronary plaques proximal to the graft anastomosis. In sensitivity analysis, bypassed native coronary arteries had higher CMA (2.0 [IQR: 0.4-7.5] vs 0.8 [IQR: 0.3-3.2]; P < 0.001) and faster disease progression (24% [IQR: 16%-43%] vs 8% [IQR: 0%-24%]; P = 0.002) than matched patients (n = 48) with comparable burdens of coronary artery disease and cardiovascular comorbidities in the absence of bypass grafting.
CONCLUSIONS
Native coronary arteries that have been bypassed demonstrate increased disease activity and more rapid disease progression than nonbypassed arteries, an observation that appears independent of baseline atherosclerotic plaque burden. Microcalcification activity is not a dominant feature of graft vasculopathy.
目的
本研究旨在描述 F-氟化钠（F-NaF）正电子发射断层扫描（PET）识别移植物血管病的潜力，并探讨冠状动脉旁路移植术（CABG）对原发性冠状动脉疾病活性和进展的影响。
背景
除了发展移植物血管病外，CABG 还被认为会加速原发性冠状动脉粥样硬化。
方法
已确诊患有冠状动脉疾病的患者接受基线 F-NaF PET、冠状动脉钙化评分、冠状动脉计算机断层扫描血管造影以及 1 年重复冠状动脉钙化评分。在有和没有 CABG 手术的患者中，定量评估 F-NaF PET 上的全血管冠状动脉微钙化活性（CMA）和钙评分的变化。
结果
在 293 名参与者（平均年龄 65 ± 9 岁，84%为男性）中，48 名（16%）在 2.7 年前（IQR：1.4-10.4 年）接受了 CABG 手术。尽管所有动脉和大多数（128 个中的 120 个[94%]）静脉移植物均未显示 F-NaF 摄取，但 7 名患者的 8 个隐静脉移植物可检测到 CMA。旁路的原生冠状动脉的 CMA 值高 3 倍（2.1 [IQR：0.4-7.5] vs 0.6 [IQR：0-2.7]；P < 0.001），1 年钙评分的进展也更大（118 个 Agatston 单位 [IQR：48-194 Agatston 单位] vs 69 [IQR：21-142 Agatston 单位]；P = 0.01），与未接受 CABG 的患者相比，这种影响主要局限于吻合口近端的原生冠状动脉斑块。在敏感性分析中，旁路的原生冠状动脉具有更高的 CMA（2.0 [IQR：0.4-7.5] vs 0.8 [IQR：0.3-3.2]；P < 0.001）和更快的疾病进展（24% [IQR：16%-43%] vs 8% [IQR：0%-24%]；P = 0.002），与在没有旁路移植的情况下具有可比的冠状动脉疾病负担和心血管合并症的匹配患者（n = 48）相比。
结论
与未旁路的动脉相比，旁路的原生冠状动脉显示出更高的疾病活性和更快的疾病进展，这一观察结果似乎独立于基线动脉粥样硬化斑块负担。微钙化活性不是移植物血管病的主要特征。
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