冠状动脉旁路移植术后症状复发患者的旁路移植血管状态评估

Assess grafts status in symptomatic patients with prior coronary artery bypass graft

目的总结冠状动脉旁路移植术后症状复发患者的临床特点,探讨并分析旁路移植血管造影检查结果.方法回顾性收集2008年1月至2018年12月间1136例冠状动脉旁路移植术后症状复发患者的临床资料.其中男868例,女268例;年龄(62.5±8.7)岁,≥65岁485例(42.7%).合并高血压852例(75.0%),高脂血症548例(48.2%),糖尿病524例(46.1%),有吸烟史713例(62.8%).结果患者旁路移植术后至症状复发(4.65±3.39)年.1073例(94.5%)表现为胸痛,146例(12.9%)旁路移植血管完全失功能,326例(28.7%)旁路移植血管完全通畅.共移植旁路血管3341根,其中失功能(狭窄、闭塞)1435(43.0%)根,263(25.5%)根为动脉旁路移植血管,1172(50.8%)根为静脉旁路移植血管.左乳内动脉旁路移植血管失功能率为22.8%(209/916),低于右乳内动脉、胃网膜右动脉、桡动脉和游离的乳内动脉.前降区失功能率(30.6%)远低于回旋区(52.7%)和右冠状动脉区(56.9%).596例(52.0%)接受经皮冠状动脉介入术再血管化治疗再发症状,其中526例(88.3%)在原位血管进行.结论冠状动脉旁路移植术后症状复发最常见为胸痛,症状复发患者的冠状动脉造影结果比较严重.再血管化治疗方式主要为PCI,原位血管是其主要手术部位.

Objective To assess the clinical characteristics and grafts status by coronary angiography(CAG)in symptomatic patients with prior coronary arteiy bypass graft(CABG).Methods A retrospective descriptive study of symptomatic patients with prior CABG who undenvent CAG was performed,1136 patients were included and analyzed.The mean age was(62.5±8.7)years,76.4%were male.There was a high prevalence of risk factors like hypertension(75.0%),dyslipidemia(48.2%),diabetes(46.1%)and smoking history(62.8%).Results The mean duration after CABG was(4.65±3.39)years.94.5%of patients had chest pain.12.9%of patients had all diseased grafts and 28.7%had all patent grafts.The proportion of diseased SVG was higher than that of diseased arterial grafts.The proportion of diseased grafts anastomosed to RCA territory was higher than that of grafts anastomosed to LCX territory or LAD territory.52.5%of patients received percutaneous coronary intervention(PCI)revascularization,and 88.3%of PCI was performed in native vessels.Conclusion The most common symptom recurring to patients with prior CABG was chest pain.Graft status in symptomatic patients with prior CABG was worse than we expected.Patients received repeated revascularization mostly by PCI and PCI was mainly performed in native vessels.