Berger P B, Bell M R, Grill D E, Simari R, Reeder G, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1996 Dec;28(7):1732-7. doi: 10.1016/s0735-1097(96)00414-7.
This study sought to determine whether successful recanalization of an occluded vein graft is associated with improvement in long-term clinical outcome.
Coronary angioplasty of occluded vein grafts is associated with a lower initial success rate and a higher complication rate than angioplasty of vein grafts with subtotal stenoses and native coronary arteries. Whether successful angioplasty improves clinical outcome is unknown.
We analyzed 77 consecutive patients who underwent angioplasty of an occluded saphenous vein coronary artery bypass graft between August 1983 and June 1994. Patients with a myocardial infarction in the previous 24 h were excluded from the study.
The mean age of the study cohort was 65 years; the mean (+/- SD) age of the treated grafts was 7.5 +/- 3.9 years. As an adjunct to balloon angioplasty, stents were used in 9% of procedures, laser in 30%, and atherectomy in 16%, and thrombolytic therapy was administered in 23% of patients. The angioplasty success rate was 71%. Major complications within 30 days of the procedure included death in 5.2% of patients, Q wave myocardial infarction in 1.3% and repeat bypass surgery in 7.8%; these events occurred with similar frequency in patients in whom angiographic success was and was not achieved. Kaplan-meier analysis comparing patients in whom angioplasty was successful (n = 55) and not successful (n = 22) revealed no differences in survival or occurrence of myocardial infarction or recurrent severe angina between the two groups in the 3 years after the procedure. Univariate analysis identified the age of the graft and use of newer interventional devices as predictors of death or myocardial infarction during this time period; procedural success was not associated with freedom from these adverse events after adjusting for these variables.
Angioplasty of occluded vein grafts is associated with a low initial success rate and a high complication rate. Successful angioplasty does not appear to reduce the occurrence of adverse events in the 3 years after the procedure.
本研究旨在确定闭塞静脉移植物的成功再通是否与长期临床结局的改善相关。
与对存在次全狭窄的静脉移植物和自身冠状动脉进行血管成形术相比，闭塞静脉移植物的冠状动脉血管成形术初始成功率较低且并发症发生率较高。血管成形术成功是否能改善临床结局尚不清楚。
我们分析了1983年8月至1994年6月期间连续接受闭塞大隐静脉冠状动脉旁路移植血管成形术的77例患者。研究排除了在过去24小时内发生心肌梗死的患者。
研究队列的平均年龄为65岁；所治疗移植物的平均（±标准差）年龄为7.5±3.9岁。作为球囊血管成形术的辅助手段，9%的手术使用了支架，30%使用了激光，16%使用了旋切术，23%的患者接受了溶栓治疗。血管成形术成功率为71%。手术30天内的主要并发症包括5.2%的患者死亡、1.3%的患者发生Q波心肌梗死以及7.8%的患者再次进行搭桥手术；这些事件在血管造影成功和未成功的患者中发生频率相似。对血管成形术成功（n = 55）和未成功（n = 22）的患者进行的Kaplan - meier分析显示，术后3年内两组在生存率、心肌梗死发生率或复发性严重心绞痛方面无差异。单因素分析确定移植物年龄和使用新型介入装置是这段时间内死亡或心肌梗死的预测因素；在对这些变量进行调整后，手术成功与避免这些不良事件无关。
闭塞静脉移植物的血管成形术初始成功率低且并发症发生率高。成功的血管成形术似乎并未降低术后3年内不良事件的发生率。
