Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery.
Outcome of reoperative coronary bypass surgery versus coronary angioplasty after previous bypass surgery.
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DOI：
10.1161/01.cir.95.4.868
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发表时间：
1997-02
期刊：
影响因子：
37.8
通讯作者：
W. Weintraub;E. Jones;D. Morris;S. King;R. Guyton;J. Craver
中科院分区：
文献类型：
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作者：
W. Weintraub;E. Jones;D. Morris;S. King;R. Guyton;J. Craver
在埃默里大学医院既往接受过冠状动脉旁路移植术（CABG）的患者中，比较了再次冠状动脉旁路移植术（CABG）（n = 1561）和基于导管的冠状动脉介入治疗（血管成形术）（n = 2613）的近期和长期结局。方法和结果手术和血管成形术程序和统计方法是标准的。前瞻性收集数据并输入计算机化数据库。通过信函、电话或导致再入院的其他事件进行随访。在血管成形术组中，2.9%的患者需要进行院内CABG。血管成形术后住院死亡率为1.2%，而再次CABG后为6.8%（P <0.0001）。复发性心绞痛经常在大约4年时出现，在血管成形术后更常见。冠状动脉旁路移植术后1年、5年和10年死亡率分别为11%、24%和49%，血管成形术后分别为6%、22%和38%。经基线差异校正的生存率不随手术选择而变化。血管成形术后有更多的额外手术。接受血管成形术的患者可分为仅接受自体冠状动脉手术的患者（n = 1545）、仅接受静脉移植的患者（n = 869）和混合手术的患者（n = 199），10年生存率分别为66%、56%和65%（P <0.0001）。结论：这些患者在医院和长期内的事件发生率很高。尽管CABG后的初始死亡率较高，但在考虑基线差异后，长期内没有差异。患者在血管成形术后更频繁地进行额外的手术。治疗的选择应考虑临床和血管造影的适用性以及患者的偏好。
BACKGROUND The immediate and long-term outcomes of reoperative coronary artery bypass surgery (CABG) (n = 1561) and catheter-based coronary intervention (angioplasty) (n = 2613) were compared in patients from Emory University Hospitals who had previous CABG. METHODS AND RESULTS The surgical and angioplasty procedures and statistical methods were standard. Data were collected prospectively and entered into a computerized database. Followup was by letter, telephone, or additional events resulting in readmission. In the angioplasty group, 2.9% required in-hospital CABG. Hospital mortality was 1.2% after angioplasty versus 6.8% after repeat CABG (P < .0001). Recurrent angina was noted frequently at about 4 years and was more common after angioplasty. One-, 5-, and 10-year mortalities were 11%, 24%, and 49% after CABG versus 6%, 22%, and 38% after angioplasty. Survival corrected for baseline differences did not vary with the choice of procedure. There were more additional procedures after angioplasty. Patients undergoing angioplasty may be divided into those with procedures only in native coronary arteries (n = 1545), only in vein grafts (n = 869), and a mixture (n = 199), with respective 10 year survivals of 66%, 56%, and 65% (P < .0001). CONCLUSIONS These patients have a high incidence of events both in-hospital and in the long term. Although initial mortality was higher after CABG, after baseline differences were accounted for, there was no difference in the long term. Patients more frequently have additional procedures after angioplasty. Choice of therapy should consider clinical and angiographic suitability and patient preference.