Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery.
Relationship between vein graft failure and subsequent clinical outcomes after coronary artery bypass surgery.
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DOI：
10.1161/circulationaha.111.040311
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发表时间：
2012-02-14
期刊：
影响因子：
37.8
通讯作者：
Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators
中科院分区：
文献类型：
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作者：
Lopes RD;Mehta RH;Hafley GE;Williams JB;Mack MJ;Peterson ED;Allen KB;Harrington RA;Gibson CM;Califf RM;Kouchoukos NT;Ferguson TB Jr;Alexander JH;Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) Investigators
静脉移植失败（VGF）是冠状动脉旁路移植术后常见的，但其与长期临床结局的关系尚不清楚。在这项回顾性分析中，我们研究了冠状动脉旁路移植术后12至18个月通过冠状动脉造影评估的VGF与随后的临床结局之间的关系。使用体外静脉移植工程项目通过转染IV（PREVENT IV）试验数据库，我们研究了1829例接受冠状动脉旁路移植术并在术后18个月内进行血管造影的患者的数据。主要结局指标为血管造影术后4年内的死亡、心肌梗死和重复血运重建。1829例患者中有787例（43%）发生VGF。97%的血管造影随访患者完成了临床随访。有VGF的患者死亡、心肌梗死或血运重建的复合事件发生率高于无VGF的患者（校正风险比，1.58; 95%置信区间，1.21-2.06; P=0.008）。这主要是由于更频繁的血运重建，在死亡（校正的风险比，1.04; 95%置信区间，0.71-1.52; P=0.85）或死亡或心肌梗死（校正的风险比，1.08; 95%置信区间，0.77-1.53; P=0.65）方面没有差异。VGF在冠状动脉旁路移植术后很常见，与重复血运重建有关，但与死亡和/或心肌梗死无关。需要进一步的研究来评估减少VGF的治疗和策略，以改善接受冠状动脉旁路移植术患者的预后。
Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes. Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21–2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71–1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77–1.53; P=0.65). VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.