The Correlation Analysis Of The Relationship Between Mean Platelet Volume And The Patency Of Graft After Coronary Artery Bypass Graft Surgery

Objective: To explore the relationship between patency of grafts undergoing coronary artery bypass grafting(CABG) and mean platelet volume(MPV).To analysis risk factors of grafts’ patency and the changes of clinical indicators of preoperation and postoperation. Respectively, in patients combining with type 2 diabetes, heart failure,or arrhythmia, to analysis the filiation between MPV and graft patency. To study platelet parameters or combined with other factors related to assess the predictive value of grafts’ patency.Methods: According to the inclusion criterias, retrospective analysis enrolled 514 cases as a result of myocardial ischemia events hospitalized in Tianjin Chest Hospital from 1st 2008 to 9st 2014,who acceptted CABG. The information of preoperative CABG of 164 patients was complete. Meanwhile collecting 194 normal subjects as control group confirmed in Tianjin Chest Hospital from 1st 2014 to 1st 2015. 514 cases were divided into graft patency groupand stenosis group. In addition, respectively according to whether complicating with diabetes, heart failure, arrhythmia or not, patients were separated into three subgroups.All patients were collected with the general clinical information, hypertension, diabetes, smoking,drinking, postoperative CABG time, myocardial infarction history, family history; collected fasting venous blood test results, records of echocardiography and chest X-ray results at the first admission. According to Syntax score to evaluate the severity of coronary arteries.Results:(1) older age, diabetes mellitus,NYHA class>Ⅱ, ejection fraction<50%and cardiothoracic ratio>50% tend to accept CABG therapy(p<0.05).(2) The independent risk factors for graft stenosis were MPV value(OR 1.550,95%OR 1.248 ~ 1.926), LP(α) value(OR 6.218,95%OR 1.624 ~ 23.810) and vein bridge numbers(OR 2.131,95%OR 1.427 ~ 3.181), and the level of HDL(OR 0.179,95%OR 0.057 ~0.560) was the favorable factor(p<0.05).(3) Comparied of preoperative and postoperative CABG, in graft patency group, the levels of HCT, MCV, and Apro-A1 decreased, RDW, Glu, EF ’s level increased(p<0.05). In graft stenosis group, PLT, MPV,TC, and LDL increased(p<0.05).(4) In the graft group, the graft stenosis rate and PLT levels increased than low-level MPVgroup and middle-level group(p<0.05); The stenosis rate of patients in the early period(postoperative time <12 months) was significantly higher than those in the late(postoperative time> 12 months)(p<0.05).(5) In type 2 diabetes subgroup, patients in graft stenosis group who MPV> 12 fl was more than that in graft patency group(p<0.05). In heart failure subgroup, the level of MPV in graft stenosis group was less(p<0.05).(6) Applying MPV to predict the rate of graft stenosis.The results drawn ROC curvewere 0.657, 95% CI(0.586 ~ 0.727). The best cutoff point of MPV is 10.45, the sensitivity of 0.497, 95% CI(0.472 ~ 0.522), and the specificity of 0.757, 95% CI(0.719 ~ 0.795);Combined with MPV, LP(a), vein bridge counts and HDL, the ROC curve was 0.770(95% CI0.706 ~ 0.833), with statistical significance(p<0.05). the best cutoff point was 0.881, the sensitivity of 0.706, 95% CI(0.671 ~ 0.741), specificity of 0.714,(0.678 ~ 0.678).Conclusion: Older age, diabetes mellitus,NYHA class > Ⅱ, ejection fraction < 50%and cardiothoracic ratio>50% tended to accept CABG therapy.The independent risk factors of stenosis of graft were MPV, LP(a), HDL levels, vein bridge vascular counts. Patients of postoperative CABG should adhere to antiplatelet therapy and lipid-lowering therapy.Regardless of type 2 diabetes subgroup or heart failure, the variation of MPV were related to the graft lesions.Associating with MPV value, LP(a) value, vein bridge count, and HDL to predict the risk of graft stenosis was possible.