THE RELATION OF RISK-FACTORS TO THE DEVELOPMENT OF ATHEROSCLEROSIS IN SAPHENOUS-VEIN BYPASS GRAFTS AND THE PROGRESSION OF DISEASE IN THE NATIVE CIRCULATION - A STUDY 10 YEARS AFTER AORTOCORONARY BYPASS-SURGERY
THE RELATION OF RISK-FACTORS TO THE DEVELOPMENT OF ATHEROSCLEROSIS IN SAPHENOUS-VEIN BYPASS GRAFTS AND THE PROGRESSION OF DISEASE IN THE NATIVE CIRCULATION - A STUDY 10 YEARS AFTER AORTOCORONARY BYPASS-SURGERY
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DOI：
10.1056/nejm198411223112101
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发表时间：
1984-01-01
影响因子：
158.5
通讯作者：
SNIDERMAN, A
中科院分区：
文献类型：
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作者：
CAMPEAU, L;ENJALBERT, M;SNIDERMAN, A
患者在隐静脉冠状动脉搭桥手术后10年接受检查，以确定他们的血管造影状况，并将这些发现与冠状动脉疾病的危险因素联系起来。术后1年的132个移植物中，只有50个移植物在术后10年未受影响。其余43个移植物变窄或闭塞。没有移植的冠状动脉疾病进展也很常见，正常血管（32例中的15例）和轻微狭窄血管（53例中的25例）都是如此。15名患者没有出现新的病变，而67名患者出现了新的病变。在移植物中，在原生血管中，或者两者都有。两组患者高血压、糖尿病或吸烟的发生率无显著差异，但新发疾病患者血浆中极低密度脂蛋白（VLDL）和低密度脂蛋白（LDL）水平较高，高密度脂蛋白（HDL）水平低于无新发疾病患者。单因素分析显示，在手术时和有新病变的患者10年检查时，血浆胆固醇和甘油三酯水平明显较高。多因素分析表明，在脂蛋白指标中，HDL胆固醇和血浆LDL载脂蛋白B水平最能区分两组。这些患者的动脉粥样硬化是一种进行性疾病，经常影响移植物和原生血管，这种疾病的病程可能与血浆脂蛋白水平有关。
Patients were examined 10 yr after saphenous-vein aortocoronary bypass surgery to determine their angiographic status and to relate those findings to the risk factors for coronary-artery disease. Of 132 grafts shown to be patent 1 yr after surgery, only 50 were unaffected at 10 yr. The remainder were narrowed (43) or occluded (39). Disease progression in coronary arteries without grafts was also frequent, both in vessels that were normal (15 of 32) and in those with minor stenosis (25 of 53). New lesions did not develop in 15 patients, whereas they did in 67.sbd.in the grafts, the native vessels, or both. There was no significant difference between the 2 groups in the incidence of hypertension, diabetes, or smoking, whereas plasma levels of very-low-density lipoproteins (VLDL) and low-density lipoproteins (LDL) were higher, and high-density lipoprotein (HDL) levels were lower in those with new disease than in those without. Univariate analysis showed that plasma cholesterol and triglyceride levels were significantly higher at the time of surgery and at the 10-yr examination in those with new lesions. Multivariate analysis indicated that among the lipoprotein indexes, levels of HDL cholesterol and plasma LDL apoprotein B best distinguished the 2 groups. Atherosclerosis in these patients was a progressive disease, frequently affecting both the grafts and the native vessels, and that the course of such disease may be related to the plasma lipoprotein levels.