非体外循环冠状动脉旁路移植术后早期桥血管闭塞对远期再次再血管化的影响

The effect of early graft occlusion on long-term revascularization after off-pump coronary artery bypass

目的:分析非体外循环冠状动脉旁路移植(OPCAB)术后早期桥血管闭塞对远期再次再血管化的影响。方法:选取2009年10月至2012年9月期间在阜外医院由单一术者施行OPCAB的连续540例患者,术后住院期间均完成冠脉CT检查评价桥血管通畅情况。长期随访采用电话或门诊随访的方式进行,主要终点指标是再次再血管化。结果:按照早期是否存在桥血管闭塞分为两组,桥血管闭塞组(30例),桥血管通畅组(510例)。平均随访时间为7.9±1.5年。桥血管闭塞组与桥血管通畅组患者相比,术前持续应用阿司匹林的比例低(46.7%vs.69.6%,P=0.0087),搭桥的血管支数多(3.6±0.8 vs.3.2±0.8,P=0.0046),远期再次再血管化的发生率高(16.7%vs.4.7%,P=0.0047)。Kaplan-Meier生存分析显示,桥血管闭塞组患者的再次血运重建的10年累积发生率要显著高于桥血管通畅组(16.67%vs.5.61%P=0.0033)。采用Cox比例风险回归模型进行多因素分析,结果显示桥血管闭塞组患者远期出现再次血运重建的风险显著增加。结论:术后早期桥血管闭塞会显著增加患者远期再次再血管化的风险。

Objective To analyze the effect of early graft occlusion on long-term revascularization after off-pump coronary artery bypass(OPCAB).Methods The data of 540 consecutive patients underwent OPCAB between October 2009 and September 2012 in our hospital were analyzed retrospectively.Coronary CT scans were completed during the postoperative hospital stay to evaluate the patency of the grafts.Long-term follow-up was obtained through phone calls,hospital records and clinical visits.The primary endpoint was revascularization.Results According to whether there was graft occlusion in the early stage,the patients were divided into two groups:graft occlusion group(n=30)and graft patency group(n=510).The average follow-up time was(7.9±1.5)years.Compared with the patients in the graft patency group,in the patients of the graft occlusion group the preoperative continuous use of aspirin was lower(46.7%vs.69.6%,P=0.0087)and the number of bypass vessels was more(3.6±0.8 vs.3.2±0.8,P=0.0046),the long-tenn revascularization rate was higher(16.7%vs.4.7%,P=0.0047).Kaplan-Meier survival analysis showed that the 10-year cumulative incidence of revascularization in the graft occlusion group was significantly higher than that in the graft patency group(16.67%vs.5.61%,P=0.0033).Cox proportional hazards regression showed that the risk of revascularization in the graft occlusion group was significantly increased in the long term.Conclusion Early postoperative graft occlusion would significantly increase the risk of long-term revascularization.