Ch Iftikhar Ali, Nasir Khurram, Chaudhry Azhar, Wu Pei-Tzu, Siddique Muhammad, Ullah Raja, Tahirkheli Mashal, Qadar Abdul, Weitzel Hunter, Jamal Rahat, Tahirkheli Naeem
South Oklahoma Heart Research, 5200 E Interstate 240 Service Rd, Oklahoma City, OK, 73135, USA.
SSM Health Saint Anthony Hospital, 1000 N Lee Ave, Oklahoma City, OK, 3102, USA.
J Cardiothorac Surg. 2025 Apr 16;20(1):197. doi: 10.1186/s13019-025-03434-6.
Despite advancements in surgical techniques, interventional procedures, novel pharmacotherapies, and other contemporary treatments, patients after coronary artery bypass graft surgery (CABG) remain at risk for graft failure and progression of native vessel disease progression. Consequently, secondary revascularization is often required.
This is a retrospective observational study evaluating the incidence, trends, and predictors of revascularization after CABG surgery.
Of 2,476 patients followed in this post-CABG study, 1458 patients received dual antiplatelet therapy (DAPT) compared to 1005 patients received aspirin monotherapy (AMT). The overall incidence of revascularization was significantly higher in the DAPT group (14.54%, 212 out of 1458) compared to the AMT group (7.07%, 71 out of 1005), with an odds ratio (OR) of 2.24 (95% CI: 1.69-2.97, p < 0.001). 770 patients who received DAPT for six months or more after surgery were compared in sub-analysis and were noted to have significantly higher incidence of revascularization compared to AMT (22.08% vs. 6.96%; OR = 3.157, 95% CI: 2.734-4.940; p < 0.001). The binary regression model revealed that younger patients ( hazard ratio (HR) = 0.964, 95% CI: 0.95-0.97; p < 0.001), diabetics (HR = 1.50, 95% CI: 1.12-2.00, p = 0.007), patients who had fewer internal mammary artery grafts (HR = 0.54, 95% CI: 0.36-0.81, p = 0.003), and patients receiving DAPT of any duration after CABG (HR = 3.47, 95% CI: 2.55-4.72, p < 0.001) were more likely to receive revascularization after CABG. The model, comprising these four predictors, was able to explain 12.8% of the variance in post-CABG revascularization (Nagelkerke R² = 0.128; p < 0.001). The survival rates were 96.5% for the DAPT group and 92.0% for AMT (odds ratio (OR) = 0.421, 95% confidence interval (95% CI): 0.269-0.658; p < 0.001).
Diabetes mellitus, younger age, fewer Internal mammary artery grafts, and the use of DAPT after CABG were strong predictors of the need for secondary revascularization.
尽管手术技术、介入治疗、新型药物疗法及其他当代治疗方法取得了进展，但冠状动脉旁路移植术（CABG）后的患者仍面临移植血管失败和自身血管疾病进展的风险。因此，通常需要进行二次血运重建。
这是一项回顾性观察研究，评估CABG手术后血运重建的发生率、趋势及预测因素。
在这项CABG术后研究中随访的2476例患者中，1458例患者接受双联抗血小板治疗（DAPT），1005例患者接受阿司匹林单药治疗（AMT）。DAPT组的血运重建总发生率（14.54%，1458例中有212例）显著高于AMT组（7.07%，1005例中有71例），优势比（OR）为2.24（95%置信区间：1.69 - 2.97，p < 0.001）。在亚分析中，比较了术后接受DAPT六个月或更长时间的770例患者，发现其血运重建发生率显著高于AMT组（22.08%对6.96%；OR = 3.157，95%置信区间：2.734 - 4.940；p < 0.001）。二元回归模型显示，年轻患者（风险比（HR）= 0.964，95%置信区间：0.95 - 0.97；p < 0.001）、糖尿病患者（HR = 1.50，95%置信区间：1.12 - 2.00，p = 0.007）、接受内乳动脉移植较少的患者（HR = 0.54，95%置信区间：0.36 - 0.81，p = 0.003）以及CABG术后接受任何时长DAPT的患者（HR = 3.47，95%置信区间：2.55 - 4.72，p < 0.001）在CABG后更有可能接受血运重建。包含这四个预测因素的模型能够解释CABG术后血运重建差异的12.8%（Nagelkerke R² = 0.128；p < 0.001）。DAPT组的生存率为96.5%，AMT组为92.0%（优势比（OR）= 0.421，95%置信区间（95% CI）：0.269 - 0.658；p < 0.001）。
糖尿病、年轻、内乳动脉移植较少以及CABG术后使用DAPT是二次血运重建需求的强预测因素。
