Mesquita A, Almeida M, Seabra-Gomes R, Baptista J, Machado F P, Palos J L, Silva A
Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide.
Rev Port Cardiol. 1998 Oct;17(10):795-800.
Increasingly over the past several years, patients have returned after coronary surgery for reintervention procedures. This reflects immediate postsurgical complications and the relentless progression of coronary artery disease in the native circulation and in the bypass grafts. Although there are randomized comparative data for coronary bypass surgery (CABG) versus percutaneous transluminal coronary angioplasty (PTCA) and medical therapy, these trials have always excluded patients with previous (GABG).
We attempted to compare the risks and benefits of percutaneous transluminal coronary angioplasty (PTCA) and repeat coronary artery bypass grafting (re-CABG) in patients with previous coronary bypass surgery (CABG).
This study examines follow up data (15.4 +/- 11.0 months) from 130 patients with previous CABG, who required either PTCA (Group A, n = 73) or re-CABG (Group B; n = 57) at a single center from 1994 to 1997. Follow up data were obtained from subsequent office visits and telephone calls. The PTCA and re-CABG groups were similar with respect to gender (86% vs 94% males), mean age (62 +/- 9 vs 59 +/- 10 years), angina CCS classes 3 and 4 (73% vs 69%), diminished left ventricular function (23% vs 26%), risk factors such as diabetes (19% vs 17%), hypercolesterolemia (49% vs 45%) and smoking (48% vs 39%) and three-vessel native coronary artery disease (67% vs 72%). The symptomatic status prior to the revascularization procedure was similar in both groups. Complete and functional revascularization was achieved in 85% of the PTCA group and in 92% of those with re-CABG (p = NS). During the hospital stay the complication rates were lower in the PTCA group. Actuarial survival was different at follow up (p = 0.04). Both PTCA and re-CABG groups resulted in equivalent event-free survival (freedom from death, myocardial infarction, unstable angina and urgent revascularization). The need for repeat revascularization at follow up was significantly higher in the PTCA group (PTCA 28% vs re-CABG 10%, p < 0.01).
In this non-randomized study of patients with previous CABG requiring revascularization procedures, PTCA resulted in lower procedural morbidity and mortality risks. At follow up, both PTCA or CABG were similar for event-free survival; PTCA offered lower overall mortality, although it is associated to a greater need for subsequent revascularization procedures.
在过去几年中，越来越多的患者在冠状动脉手术后返回进行再次干预手术。这反映了术后即刻并发症以及冠状动脉疾病在自身循环和旁路移植血管中持续进展的情况。尽管有关于冠状动脉旁路移植术（CABG）与经皮冠状动脉腔内血管成形术（PTCA）及药物治疗的随机对照数据，但这些试验一直将既往有（冠状动脉旁路移植术）的患者排除在外。
我们试图比较经皮冠状动脉腔内血管成形术（PTCA）与再次冠状动脉旁路移植术（再次CABG）在既往有冠状动脉旁路移植术（CABG）患者中的风险和益处。
本研究调查了1994年至1997年在单一中心接受过CABG手术、需要进行PTCA（A组，n = 73）或再次CABG（B组；n = 57）的130例患者的随访数据（15.4±11.0个月）。随访数据通过后续门诊就诊和电话获得。PTCA组和再次CABG组在性别（男性分别为86%和94%）、平均年龄（62±9岁和59±10岁）、心绞痛CCS分级3级和4级（73%和69%）、左心室功能减退（23%和26%）、糖尿病（19%和17%）、高胆固醇血症（49%和45%）、吸烟（48%和39%）等危险因素以及三支冠状动脉病变（67%和72%）方面相似。两组在血运重建术前的症状状态相似。PTCA组85%和再次CABG组92%实现了完全和功能性血运重建（p = 无显著差异）。住院期间，PTCA组的并发症发生率较低。随访时精算生存率存在差异（p = 0.04）。PTCA组和再次CABG组的无事件生存率（免于死亡、心肌梗死、不稳定型心绞痛和紧急血运重建）相当。随访时PTCA组再次血运重建的需求显著更高（PTCA组28% vs再次CABG组10%，p < 0.01）。
在这项针对既往有CABG且需要血运重建手术患者的非随机研究中，PTCA导致的手术发病率和死亡率风险较低。随访时，PTCA或CABG在无事件生存率方面相似；PTCA总体死亡率较低，尽管其与后续血运重建手术的更大需求相关。
