de Jaegere P P, van Domburg R T, Feyter P J, Ruygrok P N, van der Giessen W J, van den Brand M J, Serruys P W
Catheterization Laboratory, Thoraxcenter, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1996 Jul;28(1):89-96. doi: 10.1016/0735-1097(96)00104-0.
We sought to determine the role of stent implantation in vein grafts by evaluating the long-term clinical outcome and estimated event-free survival at 5 years in 62 patients and by comparing our data with those of other treatment modalities previously reported.
Patients with recurrent angina after coronary artery bypass graft surgery pose a problem. Stent implantation has been advocated in an effort to avoid repeat operation and to address the limitations of balloon angioplasty.
Patients undergoing stenting of a vein graft were entered into a dedicated data base. They were screened for death, infarction, bypass surgery and repeat angioplasty. Procedure-related events were included in the follow-up analysis. Survival and event-free survival curves were constructed by the Kaplan Meier method.
A total of 93 stents (84 Wallstent and 9 Palmaz-Shatz) were implanted in 62 patients. During the in-hospital period seven patients (11%) sustained a major cardiac event: two deaths (3%), two myocardial infarctions (3%) and three urgent bypass surgeries (5%). The clinical success rate, therefore, was 89%. During the follow-up period (median 2.5 years, range 0 to 5.9), another five patients (8%) died, 14 (23%) sustained a myocardial infarction, 12 (20%) underwent bypass surgery, and 14 (23%) underwent angioplasty. The estimated 5-year survival and event-free survival rates (free from infarction, repeat surgery and repeat angioplasty) were (mean +/- SD) 83 +/- 5% (95% confidence interval [CI] 73% to 93%) and 30 +/- 7% (95% CI 16% to 44%), respectively.
The in-hospital outcome of patients who underwent stent implantation in a vein graft is acceptable, but the long-term clinical outcome is poor. It is unlikely that mechanical intervention alone will provide a satisfactory or definite answer for the patient with graft sclerosis over the long term.
我们试图通过评估62例患者的长期临床结局及5年无事件生存率，并将我们的数据与先前报道的其他治疗方式的数据进行比较，来确定支架植入在静脉移植物中的作用。
冠状动脉旁路移植术后复发性心绞痛患者是一个难题。有人主张进行支架植入以避免再次手术并解决球囊血管成形术的局限性。
接受静脉移植物支架植入的患者被纳入一个专门的数据库。对他们进行死亡、梗死、旁路手术和重复血管成形术的筛查。与手术相关的事件被纳入随访分析。通过Kaplan-Meier法构建生存曲线和无事件生存曲线。
62例患者共植入93枚支架（84枚Wallstent支架和9枚Palmaz-Shatz支架）。住院期间，7例患者（11%）发生了严重心脏事件：2例死亡（3%），2例心肌梗死（3%），3例紧急旁路手术（5%）。因此，临床成功率为89%。在随访期间（中位时间2.5年，范围0至5.9年），又有5例患者（8%）死亡，14例（23%）发生心肌梗死，12例（20%）接受旁路手术，14例（23%）接受血管成形术。估计的5年生存率和无事件生存率（无梗死、再次手术和重复血管成形术）分别为（均值±标准差）83±5%（95%置信区间[CI] 73%至93%）和30±7%（95%CI 16%至44%）。
静脉移植物植入支架患者的住院结局是可以接受的，但长期临床结局较差。对于患有移植物硬化的患者，仅靠机械干预不太可能长期提供令人满意或明确的解决方案。
