ABSTRACT
To compare short‐and mid‐term therapeutic effect on aged patients with multi‐vessel coronary disease between minimally invasive coronary artery bypass grafting (MIDCAB) and coronary artery bypass grafting (CABG).Methods : A total of 72 patients with multi‐vessel disease , who were suitable for MIDCAB from 2016 to 2018 , were regarded as MIDCAB group .Another 96 patients with multi‐vessel disease , who were not suitable for MIDCAB , were enrolled as CABG group (received selective on‐pump CABG).Clinical data and incidence of major adverse cardio‐ and cerebrovascular events (MACCE ) within two‐year follow‐up were compared between two groups.Results : Men percentage of MIDCAB group was significantly higher than that of CABG group (83. 3% vs. 67. 7%, P＝0.022) ; compared with CABG group , there were significant reductions in percentages of left anterior descending proximal lesions (61.5% vs.34.7%) and chronic total occlusion disease (57.3% vs.34. 7%) in MID‐CAB group ( P＜0. 01 both) , there were no significant difference in other indexes between two groups , P＞ 0. 05 all.All subjects were followed up for two years , follow‐up rate was 90. 5% .There were no significant difference in incidence rates of all‐cause death and MACCE between two groups , P＞0.05 all.Conclusion : There is no signifi‐cant difference in incidence rate of short‐and mid‐term events between CABG and MIDCAB in patients with multi‐vessel coronary disease .MIDCAB is recommended for proper patients in clinic .
ABSTRACT
Objective :To compare short-term and midterm therapeutic effect between sirolimus-eluting stent implan-tation (SES-PCI) and coronary artery bypass graft (CABG) in aged patients with coronary heart disease (CHD) and multi-vessel coronary disease (MVD).Methods : Aged MVD patients undergoing selective revascularization were en-rolled and divided into CABG group (n＝301) and SES-PCI group (n＝289).Major adverse cardio-and cerebrovas-cular events (MACCE) were followed up for 30d ,one ,two and five years .Logistic multi-factor regression was used to analyze independent risk factors for different therapeutic methods .Results : Compared with CABG group after 30d follow-up ,there was significant reduction in all-cause mortality (6-3% vs.2-8%) and significant rise in a sec-ond revascularization rate (RVR ,1-3% vs.8-3%) in SES-PCI group , P＜0-05 or ＜0-01 ;compared with CABG group during one ,two and five-year follow up ,there were significant reductions in all-cause mortality [one year :(11-6% vs.4-8%) ,five years :(23-3% vs.12-1%)] and incidence rate of cerebrovascular accidents [one year :(8-6% vs .3-5%) ,five years :(18-3% vs.6-9%)] ,and significant rise in incidence rate of non-fatal myocardial infarction [one year :(6-6% vs.11-8%) ,five years :(12-0% vs.24-9%)] and a second RVR [one year :(3-0%vs.16-3%) ,five years :(9-3% vs.24-6%)] in SES-PCI group , P＜0-05 or ＜0-01- Logistic multi-factor regres-sion analysis indicated that DM and EH were independent risk factors for SES-PCI (OR＝ 45-772 ,13-218 , P＝0-001 both) ,while peripheral vascular disease was independent protective factor for SES-PCI (OR＝ 0-007 , P＝0-001).Conclusion : Compared with CABG ,there are significant reductions in short-term and midterm all-cause mortality ,and significant rise in a second RVR in MVD patients undergoing PCI .
ABSTRACT
Objective:To explore correlation between fibrinogen(Fg)level and coronary stenotic degree in aged coronary heart disease(CHD)people and its possible pathogenesis.Methods:A total of 112 patients,who were >65 years and diag-nosed as CHD by coronary angiography(CAG),were selected as CHD group.Another 108 non-CHD patients hospitalized during the same period were enrolled as non-CHD group.According to CAG results,CHD group was divided into single vessel coronary disease group(n=30,single vessel group)and multi vessel coronary disease group(n= 82,multi vessel group).Serum levels of Fg,D-dimer(D-D),C reactive protein(CRP),homocysteine(Hcy)and brain natriuretic peptide (BNP)were measured and compared between two groups.The correlation between serum Fg level and Gensini score was analyzed in CHD patients.Results:Compared with non-CHD group,there were significant rise in serum levels of Fg,D-D, triglyceride(TG),apolipoprotein B(ApoB),lipoprotein a,CRP,BNP and Hcy in CHD group,P=0.001 all;in CHD group,compared with single vessel group,there were significant rise in serum levels of Fg,D-D,ApoB,uric acid,lipo-protein a,CRP,BNP,Hcy,and significant reductions in serum levels of high density lipoprotein cholesterol,ApoA1 and ApoA1/ApoB in multi vessel group,P<0.05 or <0.01. Serum Fg level was significant positively correlated with coronary stenotic degree(Gensini score),r=0.303,P=0.001. Fg was independent risk factor of CHD(OR=2.74,95% CI:1.95~3.97,P=0.001).Conclusion:Serum Fg level is significant positively correlated with coronary stenotic degree in aged CHD patients.Its mechanism of triggering atherosclerosis may be related to risk factors such as dyslipidemia,hyper-homocysteinemia and inflammations etc.