Patients undergoing coronary artery bypass grafting (CABG) belong to the very high-risk group of atherosclerotic cardiovascular disease. Although CABG gets advantages in relieving symptoms and improving long-term outcomes, a significant risk of cardiovascular adverse events after surgery still exists and standardized secondary prevention is needed. Lipid management plays a critical role as a secondary preventive strategy in CABG. However, lipid management of CABG patients in real clinical setting is inadequate, including lack of standardized lipid-lowering strategy, low goal attainment rate, as well as poor long-term medication adherence. In recent years, a series of clinical trials have provided a lot of groundbreaking new evidence for lipid management in patients with cardiovascular diseases which offers new strategies together with objectives of lipid-lowering and comprehensive management for patients undergoing CABG. This article reviews the strategy and research progress of lipid management after CABG, aiming to provide objective reference for clinical treatment.
ObjectiveTo analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. MethodsWe reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). ConclusionStaged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.
ObjectiveTo evaluate the perioperative, short- and mid-term results of total artery bypass grafting and saphenous vein bypass grafting in three-vessel coronary heart disease patients complicated with diabetes.MethodsRetrospective analysis was performed on 46 patients (a TAR group) including 36 males and 10 females with an average age of 65.1±11.3 years who underwent total artery bypass grafting in Renji Hospital affiliated to Shanghai Jiao Tong University Medical College from 2005 to 2014. A total of 46 patients with age and gender matched admitted during the same period were selected as a control group (NCR group), in which left internal mammary artery and great saphenous vein were used as grafting vessels. Preoperative, perioperative, and postoperative (1 year and 5 years) data of the two groups were analyzed.ResultsIn terms of perioperative data, the TAR group was inferior to the NCR group in operation time, postoperative 24 h drainage volume and postoperative 24 h blood transfusion volume. However, there was no difference between the two groups in terms of perioperative mortality, ICU stay, etc. One year after surgery, there was no difference in angina pectoris recurrence, recurrent myocardial infarction or grafting vessel patency rate between the two groups. Five years after the operation, the TAR group was superior to the NCR group in angina recurrence, myocardial infarction, and grafting vessels patency rate.ConclusionFor patients with three-vessel coronary heart disease complicated with diabetes, total arterial bypass grafting can achieve better mid-term effect, although it can prolong the operation time and increase the amount of drainage and blood transfusion 24 h after operation.
Objective To investigate the effect of type 2 diabetes mellitus on the prognosis of coronary heart disease patients who had a complication of heart failure with preserved ejection fraction. Metohds A retrospective study was performed with 393 coronary heart disease patients who were complicated with heart failure with preserved ejection fraction. The diagnosis was based on the results of echocardiography and coronary angiography at the heart center of the First Affiliated Hospital of Xinjiang Medical University assessed from January 2017 to December 2017. The patients were divided into diabetic group and non-diabetic group. The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. In addition, the incidence of MACE was compared between the complete revascularization group and the incomplete revascularization group. Multivariate Cox regression analysis was used to analyze the effect of the risk factors on prognosis. Results The prevalence of hypertension and the use of ACEi/ARB in the diabetic group were higher than those in the non-diabetic group (P<0.05), and the level of high-density lipoprotein in the diabetic group was lower than that in the non-diabetic group (P<0.05). The incidence of MACE in the diabetic group (35.8%) was higher than that in non-diabetic group (25%, P=0.027). Complete revascularization improved the prognosis and reduced the incidence of MACE in both the diabetic group and non-diabetic group (P<0.05). Multivariate Cox regression analysis showed that a history of myocardial infarction (HR=0.44, 95%CI 0.20 to 1.00, P=0.049), incomplete revascularization (HR=17.28, 95%CI 2.34 to 127.43, P=0.005), and ejection fraction (HR=0.90, 95%CI 0.82 to 1.00, P=0.046) were associated with the occurrence of MACE in patients with coronary heart disease complicated with heart failure with preserved ejection fraction. Conclusion Type 2 diabetes mellitus affects the prognosis of coronary heart disease patients who have complication of heart failure with preserved ejection fraction. Complete revascularization can improve the prognosis of type 2 diabetic patients with coronary heart disease who have complications of heart failure with preserved ejection fraction.
目的 分析75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的治疗效果和临床经验。 方法回顾性分析山东省潍坊市人民医院和青岛市市立医院自2005年1月至2014年1月109例75岁以上行CABG术患者的临床资料。其中，男63例、女46例，平均年龄（78.1±4.2）岁，均为多支血管病变。术前心功能分级（NYHA） Ⅳ级23例、Ⅲ级57例、Ⅱ级29例。术中行非体外循环CABG （OPCABG） 92例，体外循环下行CABG （on pump CABG）术9例，体外循环辅助心脏不停跳下CABG （on pump beating heart CABG） 术8例。 结果 平均移植血管（2.5±1.4）支，围术期死亡4例，死亡率3.7%。其中，低心排血量综合征死亡1例，心律失常心室颤动死亡1例，肾衰和胃肠道并发症导致多器官衰竭死亡2例。术后主要并发症为心律失常、低心排血量综合征和肺部感染。105例生存患者95例获得随访，随访6～90 （45±26）个月，随访率90.5%。随访期间心源性死亡1例，非心源性死亡4例。患者心功能分级（NYHA）Ⅰ级81例，Ⅱ级18例，Ⅲ级2例，心绞痛消失。 结论 75岁以上冠心病患者行冠状动脉旁路移植术可改善患者症状，缓解心绞痛，提高生活质量，具有良好的近中期效果。
ObjectiveTo explore the effect of skeletonized left internal mammary artery (LIMA) in coronary artery bypass grafting (CABG). MethodsA total of 122 patients who underwent pure CABG were recruited in the study in the First Affiliated Hospital of China Medical University between January and April 2013. There were 77 males and 45 females with age of 41-76(62.8±10.5) years. They were randomly assigned to received CABG with skeletonized LIMAs (group A, 60 patients) or pedicle LIMAs (the group B, 62 patients) by random digital table. LIMAs were all anastomosised to the left anterior descending artery. ResultsThere was one patient failure in harvesting LIMA process in the group A and B respectively, and they were changed to saphenous vein grafts and excluded from the criteria. There were 2 and 3 patients of postoperative myocardial infarction in the group A and in the group B respectively, with incidence rate of 3.4% and 4.9% respectively (P > 0.05). One patient died in each group during hospitalization with hospital mortality rates of 1.7% and 1.6% respectively (P > 0.05). Complications such as mediastinal infection occurred zero and one patient in the group A and in the group B respectively (P > 0.05). LIMA harvesting time of the group A was statistically longer than that of the group B (30.7±7.2 min vs. 17.2±5.6 min, P < 0.05). In six months of follow-up after surgery, coronary CT showed patency rate of LIMA in the group A and in the group B was 96.8% and 100.0% respectively (P > 0.05). ConclusionThe recent effect of skeletonized LIMA as graft material in CABG is satisfactory.
Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of 64.16±8.24 years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1∶1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, and other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications were similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.
ObjectiveTo observe and analyze the short-term efficacy of different statins on acute myocardial infarction in patients with premature coronary heart disease. MethodWe selected 70 patients with acute myocardial infarction admitted into our hospital for treatment of premature coronary artery disease between January 2012 and June 2013. The patients were randomly divided into experimental group (n=35) and control group (n=35). The experimental group were treated with rosuvastatin, and the control group of patients were given atorvastatin. We observed the rate of overall efficiency within 6 months after treatment, and total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), hepersensitive C-reactive protein (hs-CRP), left ventricular ejction fraction (LVEF), and flow-mediated dilation (FMD) were also observed before and after treatment. ResultsThe overall efficacy rate in the experimental group at 6 months was 94.3% and in the control group was 88.6% with no significant difference between each other (P>0.05). TG and FMD of patients in the experimental group at 6 months did not significantly change (P>0.05), while LVEF of the experimental group was significantly higher (P<0.05), and hs-CRP, TC, LDL-C, and HDL-C of the experimental group were significantly lower than the control group (P<0.05). ConclusionsShort-term comprehensive efficacy of rosuvastatin for treatment of premature coronary artery disease in patients with acute myocardial infarction is superior to atorvastatin.
Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantlyimproved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P＜0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.