RESUMO
Objective To investigate the effect of cardiopulmonary bypass (CPB)on platelet inhibition rate(INHAA) and Aspirin resistance (AR) after coronary artery bypass grafting (CABG)surgery.Methods A total of 114 patients undergoing CABG surgery were divided into two groups:on-pump group(n=54)and off-pump group(n=60).Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0),12 hours (T1),5 days(T2),10 days (T3) and 15 days (T4) after surgery respectively.The incidence of AR was calculated.Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F =0.336,P =0.563),while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F =95.519,P =0.000).There was an interaction effect of timing and grouping(F =15.500,P =0.000).In comparison of INHAA between the two groups of on vs.off-pump at each time point,INHAA was higher in on-pump group than in off-pump group at T1 (P＜0.05),while INHAAbecame lower in on-pump group than in off-pump group at T2 (P＜0.05),and there was no statistical difference in INHAAbetween the two groups at T3 and T4 (P ＞0.05).In the on-pump group,the total difference of INHAA at different time points was significant (P＜0.05),and the INHAA was lower at T2 than at T1,T3,T4 (P＜0.05).In the off-pump group,the total difference of INHAA between different time points was significant(P＜0.05),and the INHAA was lower at T1 than at T2,T3,T4 (P＜0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜ 0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P＞0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P ＞ 0.05).Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery,and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery.
RESUMO
Objective To investigate the evaluation of plasma osteoprotegerin (OPG) measurement for assessing the prognosis of intermediate coronary lesions in elderly patients.Methods We retrospectively analyzed patients met the inclusion criteria of suspicious chest pain or confirmed coronary artery disease (CHD),and intermediate stenosis lesions (20 ％ ～ 70 ％) in 3 main coronary arteries served as target vessels for qualitative comparative analysis (QCA).Plasma OPG level was detected by protein array method,and the concentration of hypersensitive C-reactive protein (hs-CRP)was determined by enzyme-linked immunosorbent assay(ELISA).Clinical endpoints were followed up.Results A total of 890 patients with intermediate coronary stenosis were enrolled in this study,and were divided into＜60 years of age group(n＝370)and ≥ 60 years of age group(n＝520).There were statistical differences in age,smoking history,hypertension history,triglycerides (TG),high-density lipoprotein cholesterol(HDL-C),white blood cell count,OPG,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI)between the two groups.The morphological indices in coronary lesions assessed by QCA had no differences between the two groups.During a median of 24 months of follow-up,58 patients(l1.2％)had clinical endpoints events.Age,smoking history,hypertension history,TC,TG,HDL-C,white blood cell count,levels of OPG above-median,hs-CRP,SBP,DBP,and BMI were used as the independent variables,and the clinical end events as the dependent variable.Forward stepwise logistic regression analysis showed that HDL-C,levels of OPG above-median,hs-CRP were the independent risk factors in elderly patients.The risk of cardiovascular events in patients with levels of OPG above-median was 2.510 fold higher than those with levels of OPG below-median.Conclusions The high levels of OPG and hs-CRP are the independent risk factors for the occurrence of coronary heart disease in the elderly with intermediate coronary lesions.