Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Respiratory and Pulmonary Vascular Disease, Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
Clin Cardiol. 2023 Jun;46(6):680-688. doi: 10.1002/clc.24021. Epub 2023 Apr 28.
Real-world data on target vessel of percutaneous coronary intervention (PCI) for patients with prior coronary artery bypass grafting (CABG) was still limited.
A prospective cohort was examined to determine the frequency and outcomes of native coronary artery PCI versus bypass graft PCI in patients with prior CABG.
A large-sample observational study enrolled a total of 10 724 patients with coronary artery disease (CAD) underwent PCI in 2013. Two- and five-year clinical outcomes were compared between graft PCI group and native artery PCI group in patients with prior CABG.
A total of 438 cases had CABG history in the total cohort. Graft PCI group and native artery PCI group accounted for 13.7% and 86.3%, respectively. The rates of 2- and 5-year all-cause death and major adverse cardiovascular and cerebral events (MACCE) showed no significant difference between the two groups (p > .05). Two-year revascularization risk was lower in graft PCI group than native artery PCI group (3.3% and 12.4%, p < .05), but 5-year myocardial infarction (MI) risk was higher (13.3% and 5.0%, p < .05). In multivariate COX regression models, graft PCI group was independently associated with lower 2-year revascularization risk (hazard ratio [HR]: 0.21; 95% confidence interval [CI]: 0.05-0.88; p = .033), but higher 5-year MI risk than native artery PCI group (HR: 2.61; 95% CI: 1.03-6.57; p = .042). Five-year all-cause death and MACCE risk showed no difference between the two groups in model.
In patients with prior CABG underwent PCI, patients in graft PCI group had higher 5-year MI risk than patients received native artery PCI. But, 5-year mortality and MACCE was not significantly different between graft PCI group and native artery PCI group.
经皮冠状动脉介入治疗（PCI）治疗既往冠状动脉旁路移植术（CABG）患者的靶血管的真实世界数据仍有限。
本前瞻性队列研究旨在确定既往 CABG 患者中，行原位冠状动脉 PCI 与行旁路移植血管 PCI 的频率和结局。
对 2013 年行 PCI 的共 10724 例冠心病患者进行了一项大型样本观察性研究。比较了既往 CABG 患者中，旁路移植血管 PCI 组和原位动脉 PCI 组的 2 年和 5 年临床结局。
总队列中共有 438 例有 CABG 病史。旁路移植血管 PCI 组和原位动脉 PCI 组分别占 13.7%和 86.3%。两组的 2 年和 5 年全因死亡和主要不良心血管和脑事件（MACCE）发生率无显著差异（p>0.05）。2 年血运重建风险在旁路移植血管 PCI 组低于原位动脉 PCI 组（3.3%和 12.4%，p<0.05），但 5 年心肌梗死（MI）风险较高（13.3%和 5.0%，p<0.05）。多变量 COX 回归模型显示，旁路移植血管 PCI 组独立与 2 年血运重建风险较低相关（风险比 [HR]：0.21；95%置信区间 [CI]：0.05-0.88；p=0.033），但与原位动脉 PCI 组相比，5 年 MI 风险较高（HR：2.61；95% CI：1.03-6.57；p=0.042）。在模型中，两组 5 年全因死亡和 MACCE 风险无差异。
在既往 CABG 行 PCI 的患者中，旁路移植血管 PCI 组患者的 5 年 MI 风险高于行原位动脉 PCI 者。但旁路移植血管 PCI 组与原位动脉 PCI 组的 5 年死亡率和 MACCE 无显著差异。
