Relation of early saphenous vein graft failure to outcomes following coronary artery bypass surgery
Relation of early saphenous vein graft failure to outcomes following coronary artery bypass surgery
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DOI：
10.1016/j.amjcard.2005.06.067
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发表时间：
2005-11-01
影响因子：
2.8
通讯作者：
Smith, PK
中科院分区：
文献类型：
--
作者：
Halabi, AR;Alexander, JH;Smith, PK
高达20%的隐静脉移植（svg）在冠状动脉旁路移植术（CABG）后2年内失败。在当代患者群体中，早期SVG失败对主要临床事件的长期影响尚不明确。我们试图研究早期SVG失败与CABG后长期预后之间的关系。使用杜克心血管数据库，我们检查了1986年至2004年首次冠脉搭桥后1至18个月接受导管插入术的患者的基线临床和血管造影特征和临床结果。根据最严重的SVG狭窄情况，将患者分为无（< 25%）、非危重（25% ~ 74%）、危重（75% ~ 99%）或闭塞（100%）SVG疾病。我们的主要结局指标是死亡、心肌梗死或导管置入术后重复血运重建术的综合结果。在纳入分析的1243例患者中，27.9%没有，11.9%非关键，20.8%关键，39.3%闭塞性SVG疾病。在10年时，相应的调整后综合事件发生率分别为41.2%、56.2%、81.2%和67.1% （p < 0.0001）。在危重闭塞性SVG疾病患者中，大多数事件发生在置管后立即发生，主要是重复血运重建术。在多变量分析中，关键的非闭塞性SVG疾病是综合结果的最强预测因子（风险比2.36,95%可信区间2.00 ~ 2.79,p < 0.0001）。总之，在当代临床实践中，早期SVG失效与CABG术后较差的长期预后相关。(c) 2005爱思唯尔公司版权所有。
Up to 20% of saphenous vein grafts (SVGs) fail within 2 years of coronary artery bypass grafting (CABG). The long-term effects of early SVG failure on major clinical events remain undefined in contemporary patient populations. We sought to examine the relation between early SVG failure and long-term outcomes after CABG. Using the Duke Cardiovascular Databank, we examined baseline clinical and angiographic characteristics and clinical outcomes among patients who underwent catheterization 1 to 18 months after their first CABG from 1986 to 2004. Patients were classified on the basis of their worst SVG stenosis as having no (< 25%), noncritical (25% to 74%) critical (75% to 99%) or occlusive (100%) SVG disease. Our primary outcome measure was the composite of death, myocardial infarction, or repeat revascularization after catheterization. Of 1,243 patients included in the analysis, 27.9% had no, 11.9% had noncritical, 20.8% had critical, and 39.3% had occlusive SVG disease. At 10 years, the corresponding adjusted composite event rates were 41.2%, 56.2%, 81.2%, and 67.1%, respectively (p < 0.0001). Most events occurred immediately after catheterization in patients with critical and occlusive SVG disease and were primarily repeat revascularization. On multivariate analysis, critical, nonocclusive SVG disease was the strongest predictor of the composite outcome (hazard ratio 2.36, 95% confidence interval 2.00 to 2.79, p < 0.0001). In conclusion, in contemporary clinical practice, early SVG failure is associated with worse long-term outcomes after CABG. (c) 2005 Elsevier Inc. All rights reserved.