Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery - Results from a department of veterans affairs cooperative study
Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery - Results from a department of veterans affairs cooperative study
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DOI：
10.1016/j.jacc.2004.08.064
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发表时间：
2004-12-07
影响因子：
24
通讯作者：
Henderson, W
中科院分区：
文献类型：
--
作者：
Goldman, S;Zadina, K;Henderson, W
目的研究大隐静脉桥(SVG)和乳内动脉(IMA)的远期通畅性。方法冠状动脉旁路移植术后1周、1、3、6、10年行心导管置入术。结果术后10年SVG通畅率61%，IMA通畅率85%(P<；0.001)。如果SVG或IMA移植物在1周内获得专利，则该移植物在10年内获得成功的几率分别为68%和88%。左前降支(LAD)的通畅率(69%)高于右冠状动脉(56%)和回旋支(58%)(P<；0.001)。受体血管大小是移植血管通畅的重要预测因子，在直径<2.0 mm的血管中，SVG通畅率为88%，而在小于或等于2.0 mm的血管中，血管通畅率为55%(p<；0.001)。其他有意义的积极预测因素包括搭桥术后使用阿司匹林、高龄、较低的血清胆固醇和加拿大最低的功能分级(P<；0.001至0.058)。结论颈总动脉移植物10年的通畅率优于SVG。SVGs的10年通畅率好于预期，IMA移植物的10年通畅率比预期的要差。左冠状动脉前降支的10年通畅率明显高于右冠状动脉和旋转肌。预测SVG移植物开通的最好的长期指标是植入LAD并植入直径为2.0 mm的血管。(C)2004年，由美国心脏病学会基金会提供。
OBJECTIVES This study defined long-term patency of saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts.BACKGROUND This VA Cooperative Studies Trial defined 10-year SVG patency in 1,074 patients and left IMA patency in 457 patients undergoing coronary artery bypass grafting (CABG). METHODS Patients underwent cardiac catheterizations at 1 week and 1, 3, 6, and 10 years after CABG.RESULTS Patency at 10 years was 61% for SVGs compared with 85% for IMA grafts (p < 0.001). If a SVG or IMA graft was patent at 1 week, that graft had a 68% and 88% chance, respectively, of being patent at 10 years. The SVG patency to the left anterior descending artery (LAD) (69%) was better (p < 0.001) than to the right coronary artery (56%), or circumflex (58%). Recipient vessel size was a significant predictor of graft patency, in vessels >2.0 mm in diameter SVG patency was 88% versus 55% in vessels less than or equal to2.0 mm (p < 0.001). Other positive significant predictors of graft patency were use of aspirin after bypass, older age, lower serum cholesterol, and lowest Canadian Functional Class (p < 0.001 to 0.058).CONCLUSIONS The 10-year patency of IMA grafts is better than SVGs. The 10-year patency for SVGs is better and the 10-year patency for IMA grafts is worse than expected. The 10-year patency of SVGs to the LAD is better than that to the right or circumflex. The best long-term predictors of SVG graft patency are grafting into the LAD and grafting into a vessel that is >2.0 mm in diameter. (C) 2004 by the American College of Cardiology Foundation.