冠心病患者介入治疗失败后行急诊冠状动脉旁路移植术的预后

目的 探讨冠心病患者经皮冠状动脉介入治疗失败后行急诊冠状动脉旁路移植术(CABG)的预后.方法回顾性分析2002年1月至2010年12月阜外心血管病医院11例经皮冠状动脉介入治疗失败后行急诊CABG患者的临床资料,并进行随访.院内随访内容包括心脏性死亡、Q波心肌梗死、肾功能不全、神经系统事件；院外随访的研究终点为主要心血管不良事件,包括死亡、心肌梗死和靶病变血管重建.结果 患者年龄(61±5)岁.冠状动脉造影显示三支病变患者5例(45.5％).在介入治疗的靶血管病变中,9例(81.8％)位于左前降支,中、重度钙化、慢性完全闭塞及弥漫性长病变分别为3例(27.3％)、4例(36.4％)和4例(36.4％).11例患者均有行急诊CABG的指征,其中冠状动脉夹层5例(45.5％)、冠状动脉穿孔 3例(27.3％)、病变无法充分扩张1例(9.1％)、血管急性闭塞1例(9.1％)和支架脱载1例(9.1％).CABG术后随访(47±33)个月.院内随访期间,发生心脏性死亡1例(9.1％),Q波心肌梗死2例(18.2％).院外随访期间,1例(9.1％)患者死于肾功能衰竭,无因心原性事件再次住院的患者.结论经皮冠状动脉介入治疗失败后行急诊CABG多见于复杂冠状动脉病变,术后患者的长期预后良好.

Clinical outcome of patients undergoing emergent coronary artery bypass grafting following failed percutaneons coronary intervention in stent era

Objective To explore clinical outcomes of patients undergoing emergent coronary artery bypass grafting(CABG)following failed percutaneous coronary intervention(PCI)in the stent era.Methods Eleven patients who underwent emergent CABG following failed PCI from January,2002 to December 2010 were enrolled.The in-hospital follow-up included cardiac deaths,Q-wave myocardial infarction,kidney failure,and cerebrovascular events.The clinical end-point of out-hospital follow-up was the major adverse cardiac events including death,myocardial infarction,and target lesion revascularization.Results The patients were(61 ±.5)years old.Coronary angiography showed 5 patients had triple vessel lesions.There were 9 target lesions on left anterior descending antery.There were 3(27.3％)severe calcified,4(36.4％)chronic total occlusion,and 4(36.4％)diffused long lesions.Reasons for emergent CABG were dissection (n =5,45.5％),perforation(n =3,27.3％),failure to sufficient predilation(n =1,9.1％),acute closure(n =1,9.1％)and stent loss(n =1,9.1％).The average duration of follow-up was(47 ± 33)months.During in-hospital follow-up,there were 1(9.1％)cardiac death and 2(18.2％)Q wave myocardial infarction.During follow-up after hospital discharge,1 patient(9.1％)died of kidney failure,and there was no rehospitalization due to cardiac events.Conclusions Emergent CABG after failed PCI often happened in patients with complex coronary lesions.The long term outcome of patients requiring emergent CABG after failed PCI was favorable in this cohort.