Ivert T, Landou C
Scand J Thorac Cardiovasc Surg. 1981;15(2):187-98. doi: 10.3109/14017438109101045.
Seventy-nine patients underwent repeat coronary angiographies five years after coronary bypass surgery. Ninety-eight of 122 inserted grafts (80%) were patent. Significant coronary obstruction (greater than 50% reduction of luminal diameter) developed in 43/79 patients (54%) and was associated with a longer duration of angina before surgery and a lower diastolic blood pressure at the five-year follow-up, but significantly related to such factors as age, sex, type of angina, previous myocardial infarction, hypertension, hyperlipaemia, diabetes or smoking. The total number of significant obstructions increased from 230 to 308 (34%). Progression of pre-existing changes to occlusion was common and the number of occlusions increased 95% in non-grafted arteries compared with 48% in grafted arteries until the five-year evaluation. Fifty-seven of 81 new significant obstructions (70%) were found in non-grafted coronary arteries. The proximal part of the right coronary artery was most commonly affected with 19/57 (33%) of these new obstructions. A significant stenosis regressed in three patients. At the five-year follow up, 74/79 patients (94%) had less symptoms than before operation and 27/79 patients (34%) were asymptomatic. Nine patients had no angina, despite non-bypassed significant obstructions. All grafts were patent in 25/27 asymptomatic patients (93%) and in 38/52 (73%) of those with angina. Two patients had no anginal symptoms, despite occluded grafts. One had sustained a myocardial infarction and the other had symptoms of left ventricular failure. Well-developed collateral vessels were observed in 15/27 asymptomatic patients (56%) and in 45/52 (87%) of those with angina. Recurrence of symptoms was related to progressive coronary disease, graft occlusions, obstruction of anastomoses, non-bypassed obstruction or combinations of these changes.
79例患者在冠状动脉搭桥手术后五年接受了重复冠状动脉造影检查。122条植入的移植物中有98条（80%）通畅。43/79例患者（54%）出现了严重的冠状动脉阻塞（管腔直径减少超过50%），这与术前心绞痛持续时间较长以及五年随访时舒张压较低有关，但与年龄、性别、心绞痛类型、既往心肌梗死、高血压、高脂血症、糖尿病或吸烟等因素无显著相关性。严重阻塞的总数从230增加到308（34%）。在五年评估前，原有病变进展为闭塞很常见，未移植动脉的闭塞数量增加了95%，而移植动脉的闭塞数量增加了48%。81处新的严重阻塞中有57处（70%）位于未移植的冠状动脉。右冠状动脉近端最常受累，这些新阻塞中有19/57（33%）发生在此处。3例患者的严重狭窄有所消退。在五年随访时，74/79例患者（94%）的症状比手术前减轻，27/79例患者（34%）无症状。9例患者尽管存在未搭桥的严重阻塞但无心绞痛。27例无症状患者中有25例（93%）的所有移植物通畅，52例有心绞痛的患者中有38例（73%）的移植物通畅。2例患者尽管移植物闭塞但无心绞痛症状。1例发生了心肌梗死，另1例有左心室衰竭症状。27例无症状患者中有15例（56%）以及52例有心绞痛的患者中有45例（87%）观察到有发育良好的侧支血管。症状复发与进行性冠状动脉疾病、移植物闭塞、吻合口阻塞、未搭桥阻塞或这些变化的组合有关。
