Daida H, Yokoi H, Miyano H, Mokuno H, Satoh H, Kottke T E, Hosoda Y, Yamaguchi H
Division of Cardiology and Cardio-Thoracic Surgery, Juntendo University, Tokyo, Japan.
J Am Coll Cardiol. 1995 Jan;25(1):193-7. doi: 10.1016/0735-1097(94)00341-m.
To determine the potential of lipid-lowering therapy to reduce saphenous vein graft obstruction, we retrospectively studied the association between graft obstruction and serum cholesterol levels.
Atherosclerosis is the major cause of vein graft obstruction. Approximately 50% of grafts are occluded by 10 years after operation. It remains to be established whether lipid control affects long-term graft survival.
We carried out a retrospective review of all 284 patients who had undergone coronary artery bypass graft surgery at Juntendo University Hospital between 1976 and 1991 and met the following additional criteria: at least one saphenous vein graft, repeat coronary arteriography at some point after coronary artery bypass graft surgery and a serum cholesterol level > or = 200 mg/dl before operation. Saphenous vein graft obstruction rates were compared among three groups classified by serum cholesterol levels at follow-up arteriography: group I < 200 mg/dl; group II 200 to 239 mg/dl; group III > or = 240 mg/dl. A vein graft was considered obstructed if it was narrowed by > or = 70%.
In group I, 88% of grafts were not obstructed 7 years after operation. The respective rates were 61% in group II and 57% in group III (p < 0.005). This relation was true for vein grafts to the left anterior descending and other coronary arteries.
Lower serum cholesterol levels are associated with lower rates of vein graft obstruction for up to 7 years. This suggests that cholesterol-lowering therapy may improve long-term saphenous vein graft survival after coronary artery bypass surgery.
为了确定降脂治疗减少隐静脉移植血管阻塞的可能性，我们回顾性研究了移植血管阻塞与血清胆固醇水平之间的关联。
动脉粥样硬化是静脉移植血管阻塞的主要原因。术后约50%的移植血管在10年内会发生阻塞。血脂控制是否影响移植血管的长期存活仍有待确定。
我们对1976年至1991年间在顺天堂大学医院接受冠状动脉旁路移植手术且符合以下附加标准的所有284例患者进行了回顾性研究：至少有一条隐静脉移植血管，冠状动脉旁路移植手术后在某个时间点进行重复冠状动脉造影，术前血清胆固醇水平≥200mg/dl。根据随访血管造影时的血清胆固醇水平将患者分为三组：第一组<200mg/dl；第二组200至239mg/dl；第三组≥240mg/dl。如果静脉移植血管狭窄≥70%，则认为其发生阻塞。
在第一组中，88%的移植血管在术后7年未发生阻塞。第二组和第三组的相应比例分别为61%和57%（p<0.005）。这种关系在左前降支和其他冠状动脉的静脉移植血管中均成立。
较低的血清胆固醇水平与长达7年的静脉移植血管阻塞率较低相关。这表明降脂治疗可能会改善冠状动脉旁路移植术后隐静脉移植血管的长期存活。
