Kim Wan Cheol, Hirsch Gregory, Kells Catherine, Quraishi Ata-Ur-Rehman, Bishop Helen, Kidwai Bakhtiar, Title Lawrence, Beydoun Hussein, Sandila Navjot, Sumaya Wael, Elkhateeb Osama
Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Division of Cardiac Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
CJC Open. 2023 Nov 10;6(3):548-555. doi: 10.1016/j.cjco.2023.11.005. eCollection 2024 Mar.
The study assessed the outcomes of patients undergoing percutaneous coronary intervention (PCI) to bypass grafts, focusing on all-cause mortality and target vessel failure (TVF) rates.
A single-centre registry analysis included 364 patients who underwent PCI on coronary bypass grafts between 2008 and 2019. The study analyzed all-cause mortality and TVF, which encompassed target lesion revascularization, target vessel revascularization, and medically treated occluded target graft post-PCI.
The median age of the patients was 71 years (interquartile range: [IQR] 65-78), with 82.1% being male. Most patients (94.8%) received PCI on saphenous vein grafts, and the median graft age was 13.0 years (IQR: 8.4-17.6). Drug-eluting stents were used more frequently (54.4%) than bare-metal stents (45.6%), with a median stent diameter of 3.5 mm (IQR: 3-4) and length of 19 mm (IQR: 18-28). Outcome differences were not significant for PCI sites (aorto-ostial, graft body, anastomosis), use of drug-eluting stents, or use of protection devices. The 1-year mortality rate was 3.3%, whereas the combined rate of TVF or death was 20.3%. After 5 years, the mortality rate increased to 14.9%, and the combined TVF or death rate rose to 40.3%. Multivariable analyses revealed that chronic kidney disease was independently associated with mortality (hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.16-2.61, = 0.007), whereas hypertension (HR 2.42, 95% CI 1.32-4.42, = 0.004) and increased stent length (HR 1.01, 95% CI 1.00-1.02, = 0.007) were independently associated with the TVF-or-mortality outcome.
Patients undergoing PCI to bypass grafts experience considerable adverse outcomes over a 5-year period, highlighting the need for further strategies in managing this high-risk population.
本研究评估了接受冠状动脉旁路移植血管经皮冠状动脉介入治疗（PCI）患者的预后，重点关注全因死亡率和靶血管失败（TVF）率。
一项单中心注册研究分析纳入了2008年至2019年间364例接受冠状动脉旁路移植血管PCI的患者。该研究分析了全因死亡率和TVF，后者包括靶病变血运重建、靶血管血运重建以及PCI术后药物治疗的闭塞靶血管。
患者的中位年龄为71岁（四分位间距：[IQR] 65 - 78），男性占82.1%。大多数患者（94.8%）接受了大隐静脉移植血管的PCI，移植血管的中位年龄为13.0年（IQR：8.4 - 17.6）。药物洗脱支架的使用频率（54.4%）高于裸金属支架（45.6%），支架中位直径为3.5 mm（IQR：3 - 4），长度为19 mm（IQR：18 - 28）。PCI部位（主动脉开口处、移植血管体部、吻合口）、药物洗脱支架的使用或保护装置的使用对预后的差异不显著。1年死亡率为3.3%，而TVF或死亡的联合发生率为20.3%。5年后，死亡率升至14.9%，TVF或死亡的联合发生率升至40.3%。多变量分析显示，慢性肾脏病与死亡率独立相关（风险比[HR] 1.74，95%置信区间[CI] 1.16 - 2.61，P = 0.007），而高血压（HR 2.42，95% CI 1.32 - 4.42，P = 0.004）和支架长度增加（HR 1.01，95% CI 1.00 - 1.02，P = 0.007）与TVF或死亡结局独立相关。
接受冠状动脉旁路移植血管PCI的患者在5年期间经历了相当多的不良结局，凸显了对这一高危人群采取进一步治疗策略的必要性。
