Mehmet Ali ÖZATİK, Mustafa SOYLU, Oğuz TAŞDEMİR, Süha KÜÇÜKAKSU, Mehmet Kamil GÖL, Erol ŞENER, Ayşegül KUNT, Şule KORKMAZ

PTCA sonrası takipte elektif koroner bypass cerrahisine gidişte etkili faktörler

Amaç: Koroner arter hastalığının tedavi seçeneklerinden biri olan Perkütan Balon Koroner Anjiyoplasti (PTCA) sonrası restenoz gelişebilmekte ve bu hastalardan bir kısmına koroner arter bypass cerrahisi (KABC) gerekmektedir. Bu çalışmada balon anjiyoplasti sonrası elektif koroner bypass ameliyatı yapılan hastalarda etkili faktörler araştırılmıştır. Materyal ve Metod: Ocak 1995-Aralık 2000 tarihleri arasında 2990 hastaya PTCA uygulanmış ve bu hastalardan 102'sine (%3.4) ortalama 22.6 ay (1-68 ay) süre sonrası restenoz ve/veya eşlik eden diğer damar lezyonları nedeniyle koroner arter bypass ameliyatı yapılmıştır ve sonuçlar aynı sürede PTCA uygulanmış fakat restenoz ve/veya eşlik eden damar lezyonları nedeniyle KABC yapılmamış randomize seçilen 100 hastanın sonuçları ile karşılaştırılmıştır. Hastalardaki lezyonlar lokalizasyonu, darlık yüzdesi ve lezyonun tipine göre skorlandırılmıştır. Bulgular: Bu hastalardan %34.3'ünde (n = 35) anterior desanden artere (LAD), %39.5'inde (n = 40) sirkumfleks sisteme ve %37'sinde (n = 38) sağ koroner artere PTCA yapılmıştı. Anjiyoplasti yapılan damarlardan %25.2'sinde A tipi, %68.9'unda B tipi ve %6.2'sinde C tipi lezyon mevcuttu. Tek yönlü analizde, çalışma grubunun yaş ortalaması daha düşük (p = 0.011), hastalarda unstable anjina oranı (p = 0.024), sigara içimine devam (p = 0.032) ve miyokard infarktüsü geçirmemiş olma (p = 0.000) çalışma grubunda daha yüksek bulunmuştur. Skorlama sonucu daha yüksek oranda darlığa PTCA yapılması daha başarılı (p = 0.005) ve çalışma grubunda lezyon yeri skoru daha yüksek olarak bulunmuştur (p = 0.029). Sonuç: Anjiyoplasti sonrası gelişen restenoz nedeniyle hastalarda koroner bypass ameliyatı uygulaması gerekebilmekte ve bu gidişte kişiye ve lezyona özel bazı faktörler etkili olabilmektedir. Hastanın tercihi ve durumu göz önünde bulundurularak uygun hastaya uygun tedavi en doğru seçenektir.

Responsible factors effecting the course to elective coronary artery surgery in the follow-up after PTCA

Background: Restenosis can develop after percutaneous transluminal coronary angioplasty (PTCA), which is one of the treatment modalities of coronary artery disease, and some of these patients need coronary artery bypass grafting (CABG) surgery as the second intervention. In this study, we tried to evaluate the reasons for CABG in patients who underwent elective coronary artery bypass due to restenosis after PTCA. Methods: Between January 1995-December 2000, PTCA was performed in 2990 patients in cardiology clinic. Of these, 102 patients (3.4%) have undergone CABG after a mean of 22.6 months (1-68 months) due to restenosis and/or new lesions developed in coronary arteries. The risk factors of this group were compared with a control group, which included randomly chosen 100 patients who have undergone PTCA in the same period, but didn't need a secondary revascularization procedure. A scoring was applied to the lesions of the patients according to localization, type and the degree of stenosis. Results: In the study group, PTCA was applied to left anterior descending artery in 34.3% (n = 35), to circumflex system in 39.5% (n = 40) and to right coronary artery in 37% (n = 38) of patients. Type A lesion was present in 25.2%, Type B lesion in 68.9% and Type C lesion in 6.2% of the vessels on which PTCA was performed. Univariate analysis revealed that mean age of the study group was lower (p = 0.011), presence of unstable angina (p = 0.024), continuation of smoking (p = 0.032), and absence of previous myocardial infarction history (p < 0.001) were found to be significantly higher in the study group. Scoring of the lesions revealed that, if PTCA applied to higher stenosis, better outcomes are achieved and score for the localization of the lesion was higher in the study group (p = 0.029). Conclusion: Coronary artery bypass surgery might be needed due to restenosis after PTCA applications. Patient and lesion specific factors are effective for this outcome. The preference and the characteristics of the patient should be taken into consideration when deciding for the best therapeutic approach.

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