Objective: To investigate the impact of previous coronary artery bypass grafting(CABG) on long-term outcomes in patients undergoing percutaneous coronary intervention(PCI). Methods: A total of 10 724 consecutive coronary heart disease patients undergoing PCI between January and December 2013 in Fuwai hospital were prospectively included in this research. According to CABG history, the patients were divided into CABG group(437 cases) and without CABG group(10 287 cases). The patients were followed up for 2 years. Major adverse cardiovascular and cerebrovascular events(MACCE) including death, myocardial infarction, revascularization and stroke, and in-stent thrombosis following PCI were compared between the 2 groups. Multivariate Cox regression analysis was used to identify independent risk factors of poor prognosis. Results: Compared with without CABG group, CABG group were older((61±10)years vs.(58±10)years, P<0.001), and more often had diabetes(35.7%(156/437) vs. 30.0%(3 082/10 287), P=0.012), hyperlipoidemia(73.9%(323/437) vs. 67.0%(6 888/10 287), P=0.003), previous myocardial infarction(31.1%(136/437) vs. 18.7%(1 925/10 287), P<0.001), PCI history(61.6%(269/437) vs. 23.0%(2 371/10 287), P<0.001), and cerebrovascular disease(7.1%(31/437) vs. 10.9%(1 119/10 287), P=0.013). After 2 years follow-up, rates of cardiac death(1.8%(8/437) vs. 0.6%(66/10 287), P=0.010), revascularization(11.2%(49/437) vs. 8.5%(877/10 287), P=0.049) and MACCE(15.1%(66/437) vs. 12.0%(1 231/10 287), P=0.049) were significantly higher in CABG patients than in without CABG group. There were no significant difference in all cause death(2.1%(9/437) vs. 1.2%(122/10 287), P=0.114), recurrence of myocardial infarction(2.3%(10/437) vs. 2.0%(204/10 287), P=0.600), stroke(1.1%(5/437) vs. 1.4%(140/10 287), P=0.701), and in-stent thrombosis(1.1%(5/437) vs. 0.6%(61/10 287), P=0.194). Multivariate Cox regression analysis showed that previous CABG was an independent risk factor of cardiac death(HR=2.13, 95%CI 1.02-4.46, P=0.045)and revascularization(HR=1.35, 95%CI 1.01-1.81, P=0.040). However, after propensity score matched analyses(429 pairs), previous CABG was no longer an independent risk factor of cardiac mortality (HR=0.97, 95% CI 0.37-2.54, P=0.954)and revascularization(HR=1.74, 95%CI 0.94-3.21, P=0.753). Conclusion: Previous CABG is not an independent risk factor of poor prognosis in coronary heart disease patients undergoing PCI.
目的： 探讨冠状动脉旁路移植术(CABG)后行经皮冠状动脉介入治疗(PCI)患者的远期预后。 方法： 采用前瞻性研究方法，连续纳入2013年1至12月在阜外医院行PCI的冠心病患者10 724例。根据既往是否有CABG史，将患者分为既往CABG组(437例)和非既往CABG组(10 287例)。术后随访患者2年，记录主要不良心脑血管事件(包括死亡、心肌梗死、再次血运重建和再发卒中)和支架内血栓形成的发生率，比较两组患者的远期预后。采用多因素Cox回归分析患者预后不良的独立危险因素。 结果： 与非既往CABG组比较，既往CABG组年龄较大[(61±10)岁比(58±10)岁，P<0.001]，合并糖尿病[35.7%(156/437)比30.0%(3 082/10 287), P＝0.012]、高脂血症[73.9%(323/437)比67.0%(6 888/10 287), P＝0.003]、陈旧心肌梗死史[31.1%(136/437)比18.7%(1 925/10 287), P<0.001]、PCI史[61.6%(269/437)比23.0%(2 371/10 287), P<0.001]和脑血管疾病史[7.1%(31/437)比10.9%(1 119/10 287), P＝0.013]的比例较高。术后2年，既往CABG组心原性死亡[1.8%(8/437)比0.6%(66/10 287), P＝0.010]、血运重建[11.2%(49/437)比8.5%(877/10 287), P＝0.049]和主要不良心脑血管事件[15.1%(66/437)比12.0%(1 231/10 287), P＝0.049]的比例均高于非既往CABG组。全因死亡[2.1%(9/437)比1.2%(122/10 287), P＝0.114]、再发心肌梗死[2.3%(10/437)比2.0%(204/10 287), P＝0.600]、卒中[1.1%(5/437)比1.4%(140/10 287), P＝0.701]和支架内血栓形成[1.1%(5/437)比0.6%(61/10 287), P＝0.194]的比例差异均无统计学意义。多因素Cox回归分析显示，既往CABG是心原性死亡(HR＝2.13, 95%CI 1.02～4.46, P＝0.045)和血运重建(HR＝1.35, 95%CI 1.01～1.81, P＝0.040)的独立危险因素；倾向性得分匹配后，既往CABG不是心原性死亡(HR＝0.97, 95%CI 0.37～2.54, P＝0.954)和血运重建(HR＝1.74, 95%CI 0.94～3.21, P＝0.753)的独立危险因素。 结论： 既往CABG史不是行PCI患者远期预后不良的独立危险因素。.
Keywords: Angioplasty, balloon, coronary; Coronary artery bypass; Coronary disease.