【摘要】 目的　分析接受冠状动脉旁路移植术 (CABG)后的患者再次发作急性冠状动脉综合征(ACS)的时间与相关血管的关系。方法　从本院 1 997～ 2 0 0 1年间因CABG术后再次发作ACS而入院的 1 6 8例患者中 ,选出行再次冠状动脉造影的患者 4 3例 ,男 38例 ,女 5例 ,平均年龄 (5 7 9± 1 0 2 )岁 ,再次发作ACS时间在术后次日至 1 1年间。分析术后再次发作ACS的时间与罪犯血管之间的关系。结果　 (1 )由原自身冠状动脉血管病变加重导致的ACS共 1 9例 ,占 4 4 2 %,由移植血管病变导致的共 2 4例 ,占 5 5 8%,其中 1 2例移植血管病变发生在术后半年内 ,占移植血管病例的 5 0 %,且大部为吻合口病变。 (2 )从发作时间上划分 ,在术后次日至半年内发作ACS的为 1 4例 ,占所有分析病例的 32 6 %。其中 1 2例为移植血管病变所致 ,占整组病例的 2 7 9%。随时间的延长 ,引起ACS的相关血管既有移植血管 ,也有原自身冠状动脉血管远端病变加重的血管 ,但术后 3年内发作的ACS大多数由移植血管病变引起 ,检出率为 75 %,特异度为 6 3%(P <0 0 1 ) ,3年后发生的ACS主要为未移植血管的原自身冠状动脉或移植血管远端的原自身冠状动脉血管病变加重所致。 (3)所分析的 4 3例患者共置入静脉血管桥 99支 ,病变 37支 ,总病变率 37 4 %,动脉?更多还原

【Abstract】 Objective To analyze the relationship between acute coronary syndrome (ACS) recurrent time and lesions of related vessels in patients after coronary artery bypass grafting (CABG) surgery. Methods One hundred and sixtyeight patients with recurred ACS after CABG surgery were hospitalized in FuWai hospital between 1997 and 2001. Among them, 43 patients who received recoronary angiography examination were chosen for analysis of the relationship between ACS recurrent time after CABG surgery and the lesions of criminal vessels. Of the 43 patients, 38 were males and 5 were females with a mean age of 57.9±10.2 years old. The ACS recurrent time ranged from 2 days to 11 years after CABG. Results (1) The recurrence of ACS was attributed to stenosis of nongrafted native vessels induced by progressive arterial atherosclerosis in 19 patients, accounting for 44.2%. The recurrence of ACS was induced by occlusion or stenosis of grafting vessels in another 24 patients, accounting for 55.8%. In 12 of the 24 patients, ACS recurred within 6 months after CABG, which were affirmed to be induced mostly by occlusion of graft vessels. (2) In terms of time frame, 14 cases recurred ACS between the next day to half a year after CABG, accounting for 32.6% of all the analyzed cases. Of the 14 cases, 12 cases were induced by graft vessel lesions, accounting for 27.9% of all cases. As the time extended, the related vessels of ACS were either grafted vessels or the exacerbation of the native coronary vessels. ACS recurred within 3 years after CABG was induced mostly by grafted vessel lesions, with a sensitivity of 75% and a specificity of 63% (P<0.01). However, ACS recurred more than 3 years after CABG was induced mainly by progressive atherosclerosis of the nongrafted native coronary vessels or the exacerbation of the native coronary vessels distal to the grafted vessels. (3) In all these 43 patients, a total of 99 veins and 31 arteries were grafted. 37 veins and 9 arteries were found to be related vessels of ACS, with a restenosis rate of 37.4% for vein grafting and 29.0 % for artery grafting. The difference of restenosis between vein grafting and artery grafting was significant (P<0.01). (4) No associations between the occurrence of graft lesions and cardiovascular risk factors were found (P>0.05). Conclusions ACS recurred within 3 years after CABG is induced mostly by occlusion of grafting vessels, especially for those recurred within 6 months after CABG, the rate of grafted vessel lesions is higher, with a specificity of 89%. ACS recurred more than 3 years after CABG is induced mostly by lesions of nongrafted native vessels. Significant difference of restenosis rate has been observed between artery and vein grafted vessels, and restenosis rate of the grafted vessels is not associated with the existing cardiovascular risk factors. The occlusion rate of the vein grafts is higher than that of the artery grafts.更多还原