有冠状动脉旁路移植术史的急性心肌梗死患者经皮冠状动脉介入治疗的临床预后  

Clinical Outcomes for Percutaneous Coronary Intervention in Patients of Acute Myocardial Infarction With Previous History of Coronary Bypass Grafting

作　　者：刘巍[1] 周玉杰[1] 刘宇扬[1] 史东梅[1] 吕树峥[2] 陈方[2] 李志忠[2] 朱晓玲[2] 

机构地区：[1]首都医科大学附属北京安贞医院12病房,北京市100029 [2]首都医科大学附属北京安贞医院心内科,北京市100029

出　　处：《中国循环杂志》2013年第3期179-182,共4页Chinese Circulation Journal

摘　　要：目的：探讨有冠状动脉（冠脉）旁路移植术史的患者发生急性心肌梗死的经皮冠脉介入治疗策略及临床预后。方法：入选在2005—09至2011-10期间既往行冠脉旁路移植术此次因急性心肌梗死（心梗）住院并行介入治疗的患者140例，根据对梗死相关血管介入治疗的不同策略分为桥血管介入组（n=30）及冠脉自身血管介入组（n=110），对比两组患者住院期间及远期预后不良心脏事件（MACE，心性死亡，靶血管再次血运重建，心梗）。结果：患者平均桥血管年龄为（5．6±4．2）年，其中桥血管介入组30例患者对桥血管行介入治疗（动脉桥4例，大隐静脉桥26例），手术成功率为90％；冠脉自身血管介入组110例患者仅行冠脉自身血管的介人治疗，手术成功率为90．7％，两组差异无统计学意义。住院期间，桥血管介入组死亡率较冠脉自身血管介入组死亡率高（10％VS0％，P〈0．05）。平均随访2年，MACE事件两组差异无统计学意义。Coxregression研究显示糖尿病『HR4．87，95％CI（1．07—6．95），P〈0．05]以及阻塞的桥血管支数[HR3．24，95％CI（1．26—4．39），P〈0．05]为MACE的预测因子。结论：冠脉旁路移植术后发生急性心肌梗死的患者介入治疗多选择开通冠脉自身血管。与开通冠脉自身血管相比，桥血管介入死亡率高，但长期随访两者相似。糖尿病患者预后较差。Objective： Patients with prior coronary artery bypass grafting （CABG） may have worse prognosis if they thereafter suffered from acute myocardial infarction （AMI）. We investigate the treatment strategy and clinical outcome of percutaneous coronary intervention （PCI） in AMI patients with previous history of CABG. Methods： We retrospectively studied 140 consecutive patients with previous history of CABG, thereafter suffered from AMI and were treated by PCI in our hospital from 2005 to 2011. The patients were divided into 2 groups, Grafting group, n=30, the patients received graft intervention, and Native artery group, n=110, the patients received native coronary intervention. The major adverse cardiac events （MACE） for in-hospital and long term prognosis were assessed and compared between 2 groups. Results： The average graft age was （5.6 ± 4.2） years. Grafting group receive graft intervention （4 patients had arterial intervention and 26 had vein intervention）, PCI success rate was 90%; and Native artery group received native coronary artery intervention, PCI success rate was 90.7%, the difference had no statistic meaning. The in-hospital mortality in Grafting group was higher than that in Native artery group （10% vs. 0%, P〈0.05）. The average follow-up time was 2 years and the total MACE had no statistic meaning between 2 groups. Cox regression analysis indicated that diabetes （HR 4.87, 95%CI 1.07-6.95,P〈0.05） and the number of grafts （HR 3.24, 95%CI 1.26-4.39, P〈O.05） were the independent predictors for MACE. Conclusion： The patients with prior CABG thereafter suffered from AMI would rather use native coronary intervention treatment, since graft intervention had more in-hospital mortality even the long term prognosis was similar between 2 mothods. Diabetes patients may have worse prognosis.

关 键 词：桥血管 冠状动脉旁路移植术 经皮介入治疗 

分 类 号：R541[医药卫生—心血管疾病]