Abdel-Meguid A E, Whitlow P L, Simpfendorfer C, Sapp S K, Franco I, Ellis S G, Topol E J
Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
J Am Coll Cardiol. 1995 Oct;26(4):955-60. doi: 10.1016/0735-1097(95)00266-X.
This study sought to evaluate the short-term results and long-term outcome of percutaneous revascularization of ostial saphenous vein graft stenoses in a large patient series.
Previous studies have demonstrated that the results of balloon angioplasty for native coronary ostial stenoses are significantly worse than those for nonostial lesions. However, it is controversial whether interventions in patients with ostial saphenous vein grafts carry a similar prognosis.
We identified 68 consecutive patients with ostial (group I) and 72 consecutive patients with proximal, nonostial (group II) saphenous vein graft stenoses who underwent percutaneous angioplasty or directional atherectomy for a single new stenosis at the Cleveland Clinic between 1986 and 1992.
Success was achieved in 61 patients (89.7%) in group I and 64 (88.9%) in group II (p = 0.88). There were no differences in major procedural complications (death, Q wave infarction and bypass surgery) between the two groups. At a mean (+/- SD) follow-up of 23 +/- 17 months, 36 patients (64%) in group I had one or more adverse events (death, infarction, repeat coronary revascularization or cardiac-related hospital admission) compared with 34 patients (58%) in group II (p = 0.87). Twenty-eight patients (50%) were angina free in group I compared with 33 (56%) in group II (p = 0.65). During the follow-up period in group I, 7 patients died (13%), 10 had a myocardial infarction (18%), 11 had repeat bypass surgery (20%), 8 had repeat percutaneous interventions (14%), and 30 had one or more cardiac-related hospital admissions (54%). The incidence of these events was similar in group II except for a slightly higher incidence of myocardial infarction: 6 patients died (10%), 3 had a myocardial infarction (5%), 12 had repeat bypass surgery (20%), 12 had repeat percutaneous interventions (20%), and 26 had one or more cardiac-related hospital admissions (44%).
Unlike ostial native coronary disease, the clinical, procedural and follow-up profile of ostial saphenous vein graft revascularization is not significantly worse than proximal nonostial disease. This finding may be related to the overall suboptimal results of percutaneous revascularization in saphenous vein grafts compared with native coronary arteries or to the unfavorable intrinsic properties of ostial native coronary arteries compared with ostial vein grafts.
本研究旨在评估大量患者系列中隐静脉移植血管开口处狭窄经皮血管重建的短期结果和长期预后。
既往研究表明，对于冠状动脉开口处狭窄，球囊血管成形术的结果明显差于非开口处病变。然而，对隐静脉移植血管开口处病变患者进行干预的预后是否相似仍存在争议。
我们确定了1986年至1992年间在克利夫兰诊所因单一新狭窄接受经皮血管成形术或定向旋切术的68例连续性隐静脉移植血管开口处狭窄患者（I组）和72例连续性近端非开口处狭窄患者（II组）。
I组61例患者（89.7%）成功，II组64例患者（88.9%）成功（p = 0.88）。两组主要手术并发症（死亡、Q波梗死和搭桥手术）无差异。平均（±标准差）随访23±17个月时，I组36例患者（64%）发生一项或多项不良事件（死亡、梗死、再次冠状动脉血管重建或因心脏相关原因住院），II组为34例患者（58%）（p = 0.87）。I组28例患者（50%）无心绞痛，II组为33例患者（56%）（p = 0.65）。在I组随访期间，7例患者死亡（13%），10例发生心肌梗死（18%），11例接受再次搭桥手术（20%），8例接受再次经皮介入治疗（14%），30例因心脏相关原因住院一次或多次（54%）。II组这些事件的发生率相似，只是心肌梗死发生率略高：6例患者死亡（10%），3例发生心肌梗死（5%），12例接受再次搭桥手术（20%），12例接受再次经皮介入治疗（20%），26例因心脏相关原因住院一次或多次（44%）。
与冠状动脉开口处疾病不同，隐静脉移植血管开口处血管重建的临床、手术及随访情况并不比近端非开口处疾病明显更差。这一发现可能与隐静脉移植血管经皮血管重建的总体效果不如冠状动脉，或与冠状动脉开口处与隐静脉移植血管开口处的内在不良特性有关。
