皮肤冠状动脉干预后的结果在以前冠状动脉旁路移植的患者中
Naomi S Cohen1, Andrew E Ajani2, Diem Dinh3
1Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.
The American journal of cardiology
|October 29, 2024
概括
对于在冠状动脉旁路移植 (CABG) 手术后需要穿皮冠状动脉干预 (PCI) 的患者,针对本地血管或移植显示了类似的早期结果和风险调整后的长期死亡率.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血管外科 血管外科
背景情况:
- 冠状动脉旁路移植 (CABG) 手术是冠状动脉疾病的常见治疗方法.
- 皮肤冠状动脉干预 (PCI) 可能需要在以前有CABG的患者.
- 对于随后的PCI,最优的目标血管 (本源冠状动脉与旁路移植) 存在不确定性.
研究的目的:
- 为了比较临床结果和长期死亡率之间的PCI在原生冠状动脉与之前的CABG患者的旁路移植.
主要方法:
- 从墨尔本干预组注册 (2005-2018) 中回顾分析了2,764名先前接受PCI的CABG患者.
- 患者被分为原生血管PCI (n=1,928) 和移植血管PCI (n=836) 组.
- 结果包括手术并发症,30天死亡率,主要心血管和脑血管不良事件以及长期死亡率 (中位随访时间为4.8年).
主要成果:
- 移植PCI患者年龄较大,具有更多的并发症和更高风险的病变,而本土血管PCI患者更经常出现慢性全闭症.
- 移植PCI与较高的没有再流,冠状动脉穿孔和住院支架血栓形成率有关.
- 尽管移植PCI患者的非调整的长期死亡率较高 (44%对32%),但风险调整后的分析显示没有显著差异 (HR 1.13).
结论:
- 早期临床结果和风险调整后的长期死亡率与PCI在先天冠状动脉或先前CABG患者的旁路移植中进行的PCI相似.
- 绕道移植的PCI,特别是静脉移植,与程序并发症的增加有关.
- 在考虑到患者和程序因素后,针对PCI的船舶类型似乎不是长期死亡率的独立预测因素.
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