目的:多项研究表明,外支架置入可缓解CABG术后静脉移植疾病的进展。我们使用计算机断层扫描来评估外支架对围术期静脉移植物通畅性的影响。
方法:本研究评估了2018年至2021年间连续孤立的冠状动脉旁路移植术(CABG)患者的隐静脉移植物(SVG)的移植物通畅率。进行了Logistic回归分析,以比较患者和移植物水平的支持组和不支持组的结果。随着年龄,EurSCOREII,性别,糖尿病,和动脉移植物作为协变量。根据不同的协变量进行亚组分析。该研究旨在为CABG患者SVG移植物的临床结果提供有价值的见解。
结果:该研究共检查了357例符合纳入标准的患者,并评估了572例静脉移植物。在这些中,150名患者(205名SVG)接受了ExSt,而207例患者(337例SVG)未接受ExSt。研究结果表明,与未支架组相比,支架组出院时整体SVG通畅的可能性更高。两者都在移植物水平(93.8%和87.8%,比值比[OR]2.1;95%置信区间[CI]1.0-4.5;P=0.05)和患者水平(90.1%vs83.5%,OR1.8;95%CI,0.9-3.6;P=0.1)。值得注意的是,在接受两次动脉移植的亚组中,支架组和非支架组之间的差异最为显着(96.5%vs89.6%,OR3.2;95%CI,1.2-8.4;P=0.02),在EuroSCOREII较高的亚组(中位数>1.1)(98.6%vs88.6%,OR8.8;95%CI,1.1-72.7;P=0.04)。
结论:ExSt与移植物和患者水平的围手术期SVG通畅性改善相关。此外,SVG到正确的区域和高风险患者似乎有使用ExSt的优势。
OBJECTIVE: Multiple studies have shown that external stenting (ExSt) mitigates the progression of vein graft disease years after coronary artery bypass grafting (CABG). We used computed tomography to evaluate the effect of ExSt on perioperative vein graft patency.
METHODS: This study assessed graft patency rates of saphenous vein grafts (SVG) in consecutive patients with isolated coronary artery bypass grafting (CABG) between 2018 and 2021. Logistic regression analyses were conducted to compare the outcomes of supported and non-supported groups at both patient and graft levels, with age, EuroSCORE II, gender, diabetes and arterial grafts as covariates. Subgroup analyses were performed based on different covariates. The goal of the study was to provide valuable insights into the clinical outcomes of SVG in patients having CABG.
RESULTS: The study examined a total of 357 patients who met the inclusion criteria and evaluated 572 vein grafts. Of these, 150 patients (205 SVGs) received ExSt, whereas 207 patients (337 SVGs) did not receive ExSt. The study results indicated that the likelihood of overall SVG patency at discharge was higher in the stented group than in the non-stented group, both at the level of the grafts [93.8% vs 87.8%, odds ratio (OR) 2.1; 95% confidence interval (CI) 1.0-4.5; P = 0.05] and at the patient level (90.1% vs 83.5%, OR 1.8; 95% CI 0.9-3.6; P = 0.1). It is worth noting that the difference between the stented and non-stented groups was most significant in the subgroup that received 2 arterial grafts (96.5% vs 89.6%, OR 3.2; 95% CI 1.2-8.4; P = 0.02) and in the subgroup with a higher EuroSCORE II (median >1.1) (98.6% vs 88.6%, OR 8.8; 95% CI 1.1-72.7; P = 0.04).
CONCLUSIONS: The ExSt is associated with improved perioperative SVG patency at both the graft and the patient levels. Moreover, SVGs to the right territory and high-risk patients appear to have an advantage using ExSt.