Effect of first coronary artery bypass grafting on reoperative revascularization in coronary heart disease combined with chronic kidney disease patients / 中华胸心血管外科杂志

ABSTRACT

Objective:By comparing the clinical data and follow-up data of patients with coronary heart disease combined with chronic kidney disease who choose different ways of revascularization for the first time when do PCI revascularization therapy again. To investigate the effect of coronary artery bypass grafting on revascularization for the first time in patients.Methods:A retrospective analysis of clinical data of 358 patients with coronary heart disease combined with chronic kidney disease who received revascularization PCI from January 2008 to December 2017 was made. All the patients were divided into CABG group(75 cases) and PCI group(283 cases) for clinical characteristics and prognosis comparison. According to the occurrence of major adverse cardiovascular events, Cox regression was carried out to establish a risk prediction model. Results:Compared with the patients in the two groups, the ratio of current smoking(17.33% vs. 33.57%, P=0.006) and hospitalized patients with recurrent acute myocardial infarction(28.00% vs. 40.64%, P=0.045) were decreased in CABG group, the ratio of triple-vessel disease(82.67% vs. 55.12%, P<0.001) and road via femoral artery(49.33% vs. 24.03%, P<0.001) were significantly increased in the CABG group, the Gensini score[136.00(100.75, 164.00) vs. 53.00(39.00, 74.00), P<0.001] and contrast agent dosage [300(200, 400)ml vs. 200(200, 300)ml, P<0.001] were significantly higher in CABG group, but the incidence of MACCE was significantly lower in CABG group than in PCI group (40.00% vs. 57.60%, χ2=7.571, P=0.0059). According to the Cox regression of MACCE events, it was found that CABG ( RR=0.586, 95% CI 0.396-0.867, P=0.007) and higher glomerular filtration rate( RR=0.988, 95% CI 0.980-0.997, P=0.007) were the protective factors, white blood cell elevation( RR=1.100, 95% CI 1.020-1.187, P=0.013) and the application of renin-angiotensin-aldosterone system inhibitor( RR=1.380, 95% CI 1.016-1.875, P=0.039) were independent risk factors. Conclusion:Patients with coronary heart disease combined with chronic kidney disease can benefit from CABG for the first time in revascularization, when they were confronted with PCI revascularization again.