冠状动脉旁路移植术后再发心绞痛介入血运重建与药物治疗的比较研究

目的 观察冠状动脉介入治疗和单纯药物治疗对冠状动脉旁路移植术后再发心绞痛患者预后的影响.方法 回顾性分析冠状动脉旁路移植术后因再发心绞痛行冠状动脉造影检查的患者的临床资料,依据是否对桥血管和原发冠状动脉病变进行介入性血运重建分为介入治疗组(129例)和单纯药物治疗组(133例).随访1年后的主要心血管事件发生率.主要终点为主要不良心血管事件(MACE)发生情况,包括心源性死亡、非致命性心肌梗死、靶病变/靶血管血运重建等;次要终点:非靶血管血运重建和心绞痛复发情况.观察心功能和因心血管疾病再住院率.结果 随访1年,2组患者共成功随访245例,其中介入治疗组124例、药物治疗组121例.1年后MACE发生率:介入治疗组、药物治疗组分别为9.7％ (12/124)、23.1％(28/121),差异有统计学意义(P＜0.05).介入治疗组和药物治疗组心绞痛复发率为14.5％(18/124)和27.3％ (33/121),差异有统计学意义(P＜0.05).因心血管疾病再住院率介入治疗组和药物治疗组分别为10.5 (13/124)和21.5％ (26/121),差异有统计学意义(P＜0.01).介入治疗组左心室射血分数为(64±11)％,明显高于药物治疗组(58±8)％](P＜0.05).结论 经皮冠状动脉介入治疗对冠状动脉旁路移植术后桥血管和原发冠状动脉病变安全有效,中期预后优于单纯药物治疗.

Percutaneous intervention and simple drug therapy of angina pectoris after coronary artery bypass grafting

Objective To study percutaneous intervention and simple drug therapy of angina peetoris after coronary artery bypass grafting （CABG）. Methods All 262 cases with angina pectoris after CABG were divided into pereutaneous transluminal coronary intervention（PCI） group （n = 129） and simple drug therapy group （drug group） （n = 133 ）. The incidence of major adverse cardiovascular events （MACE）, revascularization of non-target vessels, cardic function and cardic readmission rate after 1 year were followed up. Results Of 262 patients with an- gina pectofis after CABG, 245 cases were followed up successfully, and 124 cases were in PCI group, the other 121 cases were in drug group. The incidence rate of MACE in PCI group9.7% （12/124） ] was higher than that in drug group 23.1% （28/121） ] （ P 〈 0.05）. Rate of angina reoccurrence in PCI group and drug group was 14.5% （18/124） and 27.3% （33/121） （P 〈0.01 ）. Rate of readmission for cardiac events in PCI group and drug group was 10.5% （13/124） and 21.5% （26/121） （P 〈0.01 ）. Left ventricular ejection fraction in PCI group was higher than that in drug group （64±11）% vs （58±8）% ,P〈0.05]. Conclusion Percutaneous intervention is effec- tive and safe for the natients with angina oectofis Dost-CABG and can imorove clinical oromaosis.