抗血小板治疗在冠状动脉旁路移植术中接受冠状动脉内膜切除术的严重冠状动脉疾病患者中的作用。

Role of Antiplatelet Therapy in Patients with Severe Coronary Artery Disease Undergoing Coronary Artery Endarterectomy within Coronary Artery Bypass Surgery.

作者信息

Balaj Ilir, Jakob Heinz, Haddad Ali, Mourad Fanar, Haneya Assad, Ali Ebrahim, Ryadi Noura, Thielmann Matthias, Ruhparwar Arjang, Shehada Sharaf-Eldin

机构信息

Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.

出版信息

J Cardiovasc Dev Dis. 2023 Mar 7;10(3):112. doi: 10.3390/jcdd10030112.

-Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel's media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed to review outcomes of patients undergoing CEA within bypass surgery who received either single-APT (SAPT) or dual-APT (DAPT). -We retrospectively evaluated 353 consecutive patients undergoing CEA within isolated coronary artery bypass grafting (CABG) in the period 01/2000-07/2019. After surgery, patients received either SAPT (n = 153), or DAPT (n = 200) for six months then lifelong SAPT. Endpoints included early, late survival, and freedom from major-adverse-cardiac and cerebrovascular events (MACCE), which were defined as incidence of stroke, myocardial infarction, need for coronary intervention (PCI or CABG) or death for any cause. -Patients' mean age was 67 ± 9.3 years; they were predominantly male 88.1%. Both DAPT- and SAPT-groups had the same extent of CAD (mean SYNTAX-Score-II: 34.1 ± 11.6 vs. 34.4 ± 17.2, = 0.91). Postoperatively, no difference between DAPT- and SAPT-groups was reported in the incidence of low-cardiac-output syndrome (5% vs. 9.8%, = 0.16), revision for bleeding (5% vs. 6.5% = 0.64), 30-day mortality (4.5% vs. 5.2%, = 0.8) or MACCE (7.5% vs. 11.8%, = 0.19). Imaging follow-up reported significantly higher CEA and total grafts patency (90% vs. 81.5% and 95% vs. 81%, = 0.017) in DAPT patients. Late outcomes within 97.4 ± 67.4 months show lower incidence of overall mortality (19 vs. 51%, < 0.001) and MACCE (24.5 vs. 58.2%, < 0.001) in the DAPT patients when compared with SAPT patients. -Coronary endarterectomy allows revascularization in end-stage CAD when the myocardium is still viable. The use of dual APT after CEA for at least six months seems to improve mid-to-long-term patency rates and survival, and reduced the incidence of major adverse cardiac and cerebrovascular events.

-冠状动脉内膜切除术（CEA）已被用于终末期冠状动脉疾病（CAD）的血运重建。CEA术后，血管中膜的受损残余部分可能导致新生内膜组织快速向内生长，这需要使用抗增殖药物（抗血小板治疗（APT））。我们旨在回顾在搭桥手术中接受单药抗血小板治疗（SAPT）或双联抗血小板治疗（DAPT）的CEA患者的预后。

-我们回顾性评估了2000年1月至2019年7月期间在单纯冠状动脉旁路移植术（CABG）中连续接受CEA的353例患者。术后，患者接受SAPT（n = 153）或DAPT（n = 200）治疗6个月，然后终身接受SAPT。观察终点包括早期、晚期生存率，以及无重大不良心脑血管事件（MACCE），MACCE定义为中风、心肌梗死、冠状动脉介入治疗（PCI或CABG）需求或任何原因导致的死亡发生率。

-患者的平均年龄为67±9.3岁；男性占比88.1%。DAPT组和SAPT组的CAD严重程度相同（平均SYNTAX评分II：34.1±11.6 vs. 34.4±17.2，P = 0.91）。术后，DAPT组和SAPT组在低心排血量综合征发生率（5% vs. 9.8%，P = 0.16）、出血修正率（5% vs. 6.5%，P = 0.64）、30天死亡率（4.5% vs. 5.2%，P = 0.8）或MACCE（7.5% vs. 11.8%，P = 0.19）方面均无差异。影像学随访报告显示，DAPT组患者的CEA和总移植血管通畅率显著更高（90% vs. 81.5%和95% vs. 81%，P = 0.017）。在97.4±67.4个月的晚期预后中，与SAPT组患者相比，DAPT组患者的总死亡率（19% vs. 51%，P < 0.001）和MACCE（24.5% vs. 58.2%，P < 0.001）发生率更低。

-当心肌仍有活力时，冠状动脉内膜切除术可实现终末期CAD的血运重建。CEA术后使用双联抗血小板治疗至少6个月似乎可提高中长期通畅率和生存率，并降低重大不良心脑血管事件的发生率。