冠状动脉旁路移植术后心绞痛复发患者冠状动脉造影特点分析

目的:总结冠状动脉旁路移植术(CABG)后心绞痛复发患者桥血管造影特点,分析桥血管病变及危险因素。方法:分析CABG术后心绞痛复发的患者430例冠状动脉造影(CAG)结果,按病变情况分为桥血管病变组253例和开通组177例,考察桥血管病变类型、桥血管病变时长、病变部位,靶血管直径等对其影响,并对其影响因素进行分析。结果:(1)左内乳动脉-前降支(LIMA)、大隐静脉-靶血管(SVG)及桡动脉-靶血管(RA)的病变率和闭塞率差异均有统计学意义(P<0.01)。(2)LIMA体部病变率高于SVG,差异有统计学意义(P<0.01),但远端吻合口病变率差异无统计学意义(P>0.05)。(3)靶血管直径≥2.0mm与直径<2.0mm病变组LIMA及SVG病变率差异均有统计学意义(P<0.05)。1~5年组,6~10年组SVG病变率高于LIMA,差异有统计学意义(P<0.05)。糖尿病、脂蛋白aLP(a)]和极低密度脂蛋白(VLDL)是SVG病变发生的危险因素,而高密度脂蛋白(HDL)为其保护因素。结论:靶血管直径≥2.0mm,SVG患者行CABG术中应用体外循环者及序贯吻合术式者桥血管病变率会偏高。

Analysis of Angiographic Characteristics after Coronary Artery Bypass Grafting in Patients with Recurrent Angina

Objective:To investigate the angiographic characteristics and risk factors that affect graft patency after coronary artery bypass graft (CABG) in patients with recurrent angina. Methods: Results of cardioangiography (CAG) in 430 patients presented with recurrent angina were analysed. Patients were divided into 2 groups according to the patency of the graft, including patency group (n=253) and diseased graft group (n=177). Effects of types of bridge lesions, duration of vascular disease, lesion location and diameter of target vessel were observed and analysed. Results:(1)There was significant difference between rates of lesions and occlusion in the left internal mammary artery (LIMA), saphenous vein grafting (SVG) and radial artery (RA, P < 0.01).There was a higher rate of lesions in LIMA than that of SVG (P < 0.01). (2) There was a significantly higher rate of lesions in LIMA than that in SVG (P < 0.01). No significant difference was found in the rate of distal anastomotic lesions between LIMA and SVG (P > 0.05). (3) There were significant differences in rates of lesions with target vessel diameter≥2.0 mm and lesions with target vessel diameter <2.0 mm between LIMA and SVG (P < 0.05). The rates of SVG lesions were higher in 1-5 year-group and 6-10 year-group than those of LIMA lesions, respectively (P < 0.05). The diabetes mellitus, lipoprotein (LP)a and very low density lipoprotein(VLDL) were risk factors of SVG lesions, while high densitv lipoprotein (HDL) was the protective factor. Conclusion: With target vessel diameter≥2.0 mm, the lesion rates were higher in SVG patients with CABG surgery.