内皮损伤和获得性阿司匹林抵抗是冠状动脉搭桥术后局灶性血栓形成和早期静脉移植失败的启动因素

作     者：Poston R.S Brown J.M. 刘少伟 

作者机构：Department of Surgery Division of Cardiac Surgery N4W94 22 S Greene St Baltimore MD 21201 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第5期

页      面：59-60页

学科分类：1007[医学-药学(可授医学、理学学位)] 1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：非体外循环下冠状动脉搭桥术 阿司匹林抵抗 静脉移植 内皮损伤 早期移植 血栓形成 术后 局灶性 获得性 冠状动脉血管造影 

摘      要：Objective: The predominant mechanism of early graft failure after coronary artery bypass grafting remains in doubt. Aspirin administered in the initial hours after coronary artery bypass grafting improves graft patency, implicating prostanoid synthesis in the pathogenesis. We hypothesized that synergy between endothelial disruption in the venous conduit and aspirin resistance would cause vein graft failure. Methods: Aspirin resistance, defined by diagnostic findings on at least two of three separate assays, was serially assessed in 225 patients undergoing off-pump coronary artery bypass grafting. Endothelial cell integrity was determined in surplus segments obtained from 408 vein grafts. The deposition of intraluminal thrombin within the vein was determined by comparing serum F1.2 levels between the coronary sinus and the aorta after grafting. Intraoperative blood flow in the grafts was measured with transit-time technology, and patency was assessed with electrocardiographically gated multichannel computed tomographic coronary angiography on day 5. Aspirin was the sole antithrombotic agent used during the study. Results: Thrombosed grafts(16/408) showed more endothelial cell loss at the time of grafting than did those grafts that remained patent(10.8% ± 21.5% vs 51.4% ± 39.1% integrity, P .01). Aspirin resistance occurred in 67 patients(30% ). Graft thrombosis was associated with aspirin resistance(P .04) and reduced endothelial integrity(P .01). These factors coexisted in 14 of 16 grafts that failed and were associated with elevated coronary sinus F1.2 levels. Conclusion: Aspirin resistance and relatively compromised venous endothelial cell integrity together marked patients whose vein grafts failed within days after off-pump coronary artery bypass grafting. These observations form a basis for identifying patients at risk and developing approaches to prevent vein injury or to selectively intervene in high-risk circumstances.