冠状动脉旁路移植术后桥血管病变的介入治疗及预后分析

目的 随访冠状动脉旁路移植术 （CABG） 术后桥血管病变成功行介入治疗患者临床主要不良心血管事件（MACE） 的发生情况， 探讨原位血管介入治疗 （NV-PCI） 和桥血管介入治疗 （graft-PCI） 策略对患者临床预后的影响。方法 选择 312 例 CABG 术后胸痛症状再发并成功行介入治疗的患者， 其中 NV-PCI 组 215 例， graft-PCI 组 97 例，平均随访 34 个月。观察患者院外心源性死亡、 非致死性急性心肌梗死（AMI）及靶血管再次血运重建（TVR）的发生情况。采用多因素 Logistic 回归分析桥血管病变介入治疗后 MACE 发生的危险因素。结果 NV-PCI 组无 MACE 生存率、 无 AMI 生存率及无 TVR 生存率均高于 graft-PCI 组， 差异有统计学意义（P＜0.05）， 2 组无死亡生存率差异无统计学意义（P＞0.05）。多因素 Logistic 回归分析显示， 长桥龄 [OR（95%CI）： 1.011（1.002~1.020）， P=0.017]、 糖尿病[OR(95%CI)： 2.375 （1.414~3.989）， P=0.001]及 graft-PCI[OR （95%CI）： 1.873 （1.090~3.219）， P=0.023]是影响桥血管介入治疗预后的独立危险因素。结论 CABG 术后桥血管病变原位血管介入治疗组临床预后明显优于桥血管介入治疗组； 桥龄、 糖尿病及 graft-PCI 是影响桥血管介入治疗临床预后的独立危险因素。

The interventional therapy and prognostic analysis of bridge vascular lesions in patients with coronary artery bypass grafting

Objective To investigate the native vessel percutaneous coronary intervention (NV-PCI) and bridge vascular interventional therapy (graft-PCI) strategies on prognosis in patients with coronary artery bypass grafting (CABG), by following up the occurrence of major adverse cardiovascular events (MACE). Methods A total of 312 patients who relapsed chest pain after the CABG and had a successful interventional treatment were divided into two groups: 215 patients for NVPCI group and 97 patients for graft-PCI group. We observed cardiac death, acute myocardium infarction (AMI) and target vessel revascularization (TVR) after visiting the patients out of hospital for 34 months on average. The risk factors of MACE were analyzed by multivariable Logistic regression after the interventional treatment for the bridge vascular lesions. Results The proportions of patients without MACE, AMI and TVR were significantly higher in NV-PCI group than those in graft-PCI group (P＜0.05). There were no significant differences in death rate and survival rate between two groups (P＜ 0.05). Multivariable Logistic regression analysis showed that age of bridge [OR(95%CI):1.011(1.002-1.020), P=0.017], diabetes mellitus [OR(95%CI):2.375 (1.414-3.989), P=0.001] and graft-PCI [OR(95%CI):1.873(1.090-3.219)，P=0.023] were independent risk factors for prognosis of impacting the bridge vascular interventional treatment. Conclusion The clinical prognosis is much better in NV-PCI group than that of graft-PCI group. The age of bridge, diabetes mellitus and graft-PCI are independent risk factors for clinical prognosis of impacting the bridge vascular interventional treatment.