冠状动脉旁路移植术后再次血运重建策略中国专家共识2022版

中华胸心血管外科杂志2022年12月第38卷第12期Chin】Thorac Cardiovase Surg,Decemb世2022，Vol.38No.12705··指南·共识·规范·冠状动脉旁路移植术后再次血运重建策略中国专家共识(2022版)中华医学会心血管病学分会介入学组中华医学会心血管病学分会微循环学组中国老年医学学会心血管病学分会北京心血管疾病防治研究会心内外交叉分会通信作者：史冬梅Email:ansdm2000@163.com赵强zq11607@rjh.com.cn周玉杰azzyj12@163.com杨跃进yangyjfw@126.com【摘要】随着冠状动脉旁路移植术的发展，冠状动脉旁路移植术手术例数不断增长，且需要再次血运重建患者数量也不断增多并引起关注。冠状动脉旁路移植术后桥血管及自然冠状动脉粥样硬化进展迅速，其复杂程度也高于未接受冠状动脉旁路移植术的患者。目前冠状动脉旁路移植术后再次血运重建策略具有挑战性，需要心脏团队共同制订，而且缺乏循证依据。因此本共识编写专家组结合近几年国内外指南共识、循证医学证据及临床实践经验编写了《冠状动脉旁路移植术后再次血运重建策略中国专家共识(2022版)》以供临床参考，推动冠心病治疗水平的提高。【关键词】冠状动脉疾病冠状动脉旁路移植术再次血管重建策略专家共识D01:10.3760/cma.i.cnl12137-20220715-015542022 Chinese expert consensus on the strategies for revascularization after coronary artery by pass graftingIntenentional Cardiology Working Group of Chinese Society of Cardiology,Cardiovaseular Disease Prevention and ManagementWorking Group of Chinese Society f Cardiology.Cardioaseular Disease Branch of Chinses Geratries Society,Society f Cardiol-ogiss and Cardiae Surgeons of Beijing Cardiowasalar Disease Prevention&Treatment AssociationCorresponding author:Shi Dongmei Email ansdm2000@163.comZhao Qiangs1 1607@rih.com.cnZhou Yujieuzyj12@163.comYang Yueinyangyifie@126.comAbstract With the development of coronary artery bypass grafting CABG),the number of patients undergoing CABG ison the rise,and thus the number of patients requiring revascularization afier CABG is also increasing,which draws considerableattention.Atherosclerosis of both bypass grafts and native corary arteries progesses rpidly in patients undergoing CABG,and coronary lesions are more complex than in non-CABG patients.At present,the strategies for revascularization after CABGare still controversial.Therefore,based on the domestie and foreign guidelines and consensus,evidence-based evidence,andclinical practice experience in recent years,the expert panel has compiled the 2022 Chinese expert consensus on the strategiesfor revascularization after coronary artery bypass grafting to promote the development of coronary artery disease treatment.【Key words】Coronary artery diseaseCoronary artery bypass graftingRevascularization StrategyExpertconsensusD0I:10.3760/ma.j.ml12137-20220715-01554随着我国人口老龄化的快速发展，冠状动脉将其中CHD患者约为1100万。患者冠状动脉病样硬化性心脏病(coronary heart disease,CHD,简称变部位和病变程度决定血运重建策略的选择。目前冠心病)已经成为严重威胁我国人民健康的最主要CHD血运重建方式主要包括经皮冠状动脉介入治疾病之一。据推算我国心血管疾病患者达2.9亿，疗(percutaneous coronary intervention,PCI)、冠状动脉旁路移植术(（coronary artery bypass grafting,注：本文首次发表在《中华医学杂志》，2022,102(36)：2844-2853.D01:10.3760/ma.j.m112137-20220715-01554CABG)两种方式及两者相结合的杂交血运重建方hybrid coronary revascularization,HCR)CABG