经皮腔内冠状动脉成形术（PTCA）成功后进行冠状动脉旁路移植术（CABG）：PTCA会增加CABG的风险吗？

Coronary artery bypass grafting (CABG) after successful percutaneous transluminal coronary angioplasty (PTCA): is PTCA a risk for CABG?

作者信息

Kalaycioğlu S, Sinci V, Oktar L

机构信息

Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.

出版信息

Int Surg. 1998 Jul-Sep;83(3):190-3.

PMID:9870771

Abstract

We studied patients who underwent a coronary artery bypass grafting (CABG) procedure with previous percutaneous transluminal coronary angioplasty (PTCA). Forty patients had undergone successful PTCA, and required subsequent CABG, between January 1993 and June 1996 (Group I). These patients were matched with 40 patients surgically revascularized without previous PTCA at the same term (Group II). There were no statistical differences among sex, diabetes mellitus, hypertension, family history, smoking, hypercholesterolemia and prior myocardial infarction within the groups. The mean ages were 50.7+/-9.4 and 54.7+/-7.7 years, respectively, in Group I and Group II (P = 0.02). Preoperative mean ejection fraction values were 59+/-5% in Group I and 56+/-7% in Group II (P = 0.01). The mean follow-up period was 21.0+/-9.8 months (1-38 months) for both groups. CABG operations were performed 11.4+/-6.0 months after PTCA. Number of grafts were 2.1+/-0.7 and 2.3+/-0.8 per patient in Group I and Group II, respectively. Mean aortic cross-clamping times were 18+/-3 and 17+/-4 min/graft (P = 0.01) and cardiopulmonary bypass (CPB) times were 34+/-7 and 29+/-7 min for Group I and Group II, respectively, (P = 0.0001). The duration of hospital stay were 9.1+/-2.5 days for Group I and 8.0+/-1.1 days for Group II (P = 0.008). Freedom from angina at the end of 3 years was 82.5% and 87.5% for Group I and Group II, respectively. One early and two late deaths occured in Group I. One early death and one late death occured in the other group. Survival rates for three years were 92.5% and 95% in Group I and in Group II, respectively. In conclusion, the method of initial revascularization procedure should be considered carefully, as markers of more severe disease may indicate primary CABG and avoidance of an initial PTCA. The initial PTCA may complicate the operation and may increase postoperative morbidity and mortality.

摘要

我们研究了既往接受过经皮腔内冠状动脉成形术（PTCA）并随后接受冠状动脉旁路移植术（CABG）的患者。1993年1月至1996年6月期间，40例患者成功接受了PTCA，并随后需要进行CABG（第一组）。这些患者与同期40例未接受过PTCA而接受手术血运重建的患者相匹配（第二组）。两组患者在性别、糖尿病、高血压、家族史、吸烟、高胆固醇血症和既往心肌梗死方面无统计学差异。第一组和第二组的平均年龄分别为50.7±9.4岁和54.7±7.7岁（P = 0.02）。第一组术前平均射血分数值为59±5%，第二组为56±7%（P = 0.01）。两组的平均随访期均为21.0±9.8个月（1 - 38个月）。CABG手术在PTCA后11.4±6.0个月进行。第一组和第二组患者每人的移植血管数量分别为2.1±0.7和2.3±0.8。第一组和第二组的平均主动脉阻断时间分别为18±3和17±4分钟/移植血管（P = 0.01），体外循环（CPB）时间分别为34±7和29±7分钟（P = 0.0001）。第一组的住院时间为9.1±2.5天，第二组为8.0±1.1天（P = 0.008）。三年末无心绞痛的比例在第一组和第二组分别为82.5%和87.5%。第一组发生1例早期死亡和2例晚期死亡。另一组发生1例早期死亡和1例晚期死亡。第一组和第二组的三年生存率分别为92.5%和95%。总之，应仔细考虑初始血运重建程序的方法，因为更严重疾病的指标可能提示首选CABG并避免初始PTCA。初始PTCA可能使手术复杂化，并可能增加术后发病率和死亡率。