摘要
背景:冠状动脉搭桥术(CABG)后再介入治疗常见。作者旨在确定其发生率以及影响再介入治疗必要性和倾向性的患者特征和手术技巧。方法和结果:1971—1998年,共有48758例患者接受了首次单一CABG治疗,对其进行每年1000例患者每5年1次的积极随访(n=26927)。采用与时间相关的多变量分析建立免于初次冠状动脉再介入治疗(再手术或经皮冠状动脉介入)的模型,并确定与初次再介入治疗相关的患者和手术操作特征。
BACKGROUND -Reintervention after coronary artery bypass grafting(CABG) is common. We sought to determine its occurrence and identify patient characteristics and operative techniques that influence the need or bias for reintervention. METHODS AND RESULTS -From 1971 to 1998, 48 758 patients underwent primary isolated CABG, and 1000 patients per year were actively followed-up every 5 years(n=26 927). A multivariable time-related analysis was performed to model freedom from first coronary reintervention(either reoperation or percutaneous coronary intervention) and identify patient and operative characteristics associated with first reintervention. A total of 3997 patients underwent coronary reintervention, percutaneous in 1638 and reoperation in 2359. Freedom from reintervention was 99%, 96%, 88%, 73%, 60%, and 46%at 1, 5, 10, 15, 20, and 25 years, respectively. Risk of reintervention(hazard function) demonstrated a short, rapidly declining early phase followed by a longer, slowrising late phase. Patient variables increasing the likelihood of coronary reintervention included younger age(P< 0.0001), higher triglycerides(P=0.002), lower high-density lipoprotein(P=0.006), diabetes mellitus(P< 0.0001), and more extensive coronary artery disease(P=0.0005). Increasing extent of arterial grafting performed at primary operation decreased the likelihood of coronary reintervention(P< 0.0001). CONCLUSIONS -Reintervention after primary CABG is common. Risk factors for arteriosclerosis and type of bypass conduit influence the need or bias for repeat coronary therapy. Aggressive post-CABG risk factor reduction and extensive arterial grafting at primary operation should decrease coronary reinterventions.
