Objective To compare the prognosis of vascular in situ and bridge vessel percutaneous coronary intervention ( PCI) therapy strategies in patients with recurrent angina after coronary artery bypass grafting ( CABG) . Methods A total of one hundred and two patients with recurrent angina after CABG from January 2008 to January 2016 were involved in this study and were divided into two groups according to interventional therapy strategy:74 patients in the vascular in situ PCI group ( in situ group,74 cases) and 28 patients for bridge vessel PCI group ( bridge vessel group,28 cases) . The patients have been followed up for (33. 6± 10. 2) months. The major adverse cardiovascular events ( MACE) of the two groups were recorded, including non?fatal acute myocardial infarction ( AMI) ,target vessel revascularization ( TVR) and cardiac death, and multivariate logistic regression analysis was used to analyze the related factors of MACE. Results Compared with the bridge vessel group,the non?MACE survival rate,non?AMI survival rate and non?TVR survival rate of the in situ group were significantly increased ( ( 71. 6% ( 53/74 ) vs. 57. 1% ( 16/28 ) , 93. 2% ( 69/74 ) vs. 82. 1% (23/28),81. 1% (60/74) vs. 67. 9% (19/28) ),the differences were statistically significant (χ2=8. 141,4. 219,5. 436, P<0. 05) . Multivariable logistic regression analysis showed that age of bridge ( OR=1. 023,95%CI 1. 005-1. 026,P=0. 019) ,diabetes mellitus ( OR=2. 386,95%CI 1. 425-3. 991,P=0. 003) and bridge vessel PCI (OR=1. 884,95%CI 1. 093-3. 220,P=0. 025) were factors that affect the clinical prognosis in patients with recurrent angina pectoris after CABG. Conclusion The clinical prognosis of the in situ PCI is better than bridge vascular PCI in patients with recurrent angina after CABG,while the age of bridge, diabetes mellitus, vascular interventional treatment are factors for the effect of interventional therapy patients prognosis. The clinical prognosis is much better in native vessel PCI than that of bridge vessel PCI in patients with recurrent angina after CABG. The age of bridge,diabetes mellitus and bridge vessel PCI are the factors that affect the clinical prognosis in the patients.%目的 对比原位血管与桥血管介入治疗冠状动脉旁路移植术(CABG)术后心绞痛复发患者的临床预后.方法 选择2008年1月至2016年1月接受CABG且术后心绞痛复发102例患者,以不同的介入治疗策略分成原位血管介入治疗组(原位组,74例)及桥血管介入治疗组(桥血管组,28例),随访(33.6±10.2)个月;统计两组患者主要不良心血管事件(MACE)生存情况,包括非致死性急性心肌梗死(AMI)、靶血管血运重建(TVR)以及心源性死亡,并以多因素Logistic回归分析统计该类患者发生MACE相关因素.结果 与桥血管组比较,原位组无MACE生存率[71.6%(53/74)与57.1%(16/28)]、无AMI生存率[93.2%(69/74)与82.1%(23/28)]、无TVR生存率[81.1%(60/74)与67.9%(19/28)])均明显升高,差异有统计学意义(χ2值分别为8.141、4.219、5.436,P均<0.05).多因素Logistic分析提示,桥龄(OR=1.023,95%CI 1.005~1.026,P=0.019)、糖尿病(OR=2.386,95%CI 1.425~3.991,P=0.003)、桥血管介入治疗(OR=1.884,95%CI 1.093~3.220,P=0.025)是CABG术后心绞痛复发患者影响临床预后相关危险的因素.结论 CABG术后心绞痛复发患者实施原位血管介入治疗策略临床预后较桥血管介入治疗优势明显;而桥龄、糖尿病、桥血管介入治疗是该类患者影响介入治疗预后的危险因素.
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