ABSTRACT
Objective:To evaluate the prognosis of off-pump coronary artery bypass grafting combined(OPCABG) with coronary endarterectomy(CE) treating the diffuse coronary artery disease.Methods:From January 2012 to December 2014, the clinical data of 2 496 OPCABG patients in our department were retrospectively analyzed, and they were divided into OPCABG group and OPCABG+ CE group. After 1∶1 matching via the propensity score matching method, the perioperative prognosis, long-term survival and adverse cardiovascular and cerebrovascular events(MACCE) were compared between the two groups.Results:A total of 238 pairs of patients were included after propensity score matching. The incidence of postoperative AMI in the OPCABG+ CE group was significantly higher than that in the OPCABG group(5.04% vs. 1.68%, P=0.042). With an average follow-up of 7.3 years, there was no significant difference in the cumulative survival rate(92.44% vs. 88.65%, P=0.159) and long-term MACCE(10.92% vs. 15.13%, P=0.173) between the two groups. Compared with the OPCABG group, the recurrence of angina pectoris(CCS grade Ⅲ-Ⅳ) in the OPCABG+ CE group increased significantly(20.16% vs. 12.60%, P=0.026). Conclusion:The risk of early AMI and long-term angina recurrence after OPCABG+ CE is significantly increased, but the long-term survival and MACCE of OPCABG+ CE and OPCABG are comparable.
ABSTRACT
Objective To summarize the clinical features of patients with diffuse coronary artey diseases,and evaluate the clinical efficacy of off-pump coronary artery bypass grafting(OPCABG) combined with selective coronary venous bypass grafting (SCVBG).Methods Retrospectively analyzed the clinical data of 61 patients with diffuse right coronary stenosis undergoing operation of OPCABG + SCVBG from January 2007 to December 2013,and couducted the comparative study of the patients who underwent OPCABG during the same period based on propensity score.Patients were divided into SCVBG group(61 cases,underwent OPCABG + SCVBG) and control group(60 cases,matched by propensity score and underwent OPCABG without SCVBG).Results Compared with control group,the rate of myocardial infarction in SCVBG group was higher (67.2％ vs.46.7c％,P ＜0.05),the heart rate was faster[(69.92 ± 15.82) bpm vs.(64.48 ± 13.72) bpm,P ＜ 0.05],the low density lipoprotcin and triglyceride were higher[(2.67 ± 0.78) mmol/L vs.(2.37 ± 0.78) mmol/L (1.84 ± 0.79) mmol/L vs.(1.36 ± 0.60) mmol/L,both P ＜ 0.05] and the troponin I was higher in the first postoperative day [0.85 (0.29,3.15)μg/L vs.5.09 (2.02,13.03)μg/L,P ＜ 0.05].The perioperative(postoperative) mortality(1.6％ vs.0) and the long-term survival curve difference had no statistically significance(P ＞0.05).Conclusion Patients with coronary artery disease should pay more attention to the control of heart rate and blood lipids,poorly controlled heart rate and high blood lipids are the important factors for the development of coronary heart disease.The exact efficacv of selective coronary vein arterialization for diffuse coronary artery disease is confirmed through the small sample comparative study.