| Objective:A retrospectively contrast study is performed on the on-pump beating coronary artery bypass grafting(OPBCABG)and the on-pump coronary artery bypass grafting(CABG).The Syntax score and Syntax-Ⅱ score are used to evaluate the long-term prognosis,aiming at exploring the impact of the two surgical procedures on perioperative and long-term prognosis of patients and providing a certain reference for the selection of clinically surgical procedures.Methods:A total of 100 patients who underwent coronary artery bypass grafting at the cardiac surgery department of Su Bei Hospital from January 2012 to December 2016 were selected:42 cases in the CABG group and 58 cases in the OPBCABG group.All the selected cases were examined by test method such as blood routine and electrocardiogram before surgery to exclude the contraindications.Coronary angiography was used to diagnose coronary heart disease and to locate vascular lesion segments.The inclusion criteria for the patients is as follows:1.Coronary Artery Disease(left main or three-vessel lesions);2.Perioperativestatistics,surgical records and the data of selected patients such as dynamic image of coronary angiography can be checked;3.Follow-up can be effectively finished.Exclusion criteria:1.The patient’s original data were incomplete or the angiography was performed by other hospitals;2.The patients had a previous history of coronary revascularization surgery or was merged with other cardiac macrovascular disease requiring concurrent surgery treatment.3.Patients underwent emergency coronary artery bypass grafting 4.The Patients died during the perioperative period.The baseline data(gender,age,endogenous creatinine clearance,past medical history,etc.),the general conditions(postoperative intubation time,operation time,intraoperative blood loss),the condition of perioperative recovery and complications were compared between the two groups(mechanical assisted breathing time,Cardiac Surgery Associated Acute Kidney injury,new arrhythmia,etc.).The Syntax score and Syntax-Ⅱ score are calculated simultaneously;the incidence of long-term clinical endpoints are followed up,including the all-cause death,the recurrent myocardial infarction,the recurrent stroke,and the revascularization;the discrepancy of Long-term prognosis between the two surgical groups are compared under different risk stratifications.The preliminary discussion of whether Syntax or its derivative Syntax-Ⅱ scoring system can make effectively risk stratification in patients with coronary heart disease are in progress.Statistical data were processed by using SPSS 24.0statistical software.Results:The average follow-up time is 36 months(range from 32 to 40 months).In terms of preoperative baseline data,the statistics of the two groups has homogeneity in age(67.09±6.90:66.83 ± 7.20),left ventricular ejection fraction(57.86 ± 6.41:55.90± 6.79),and male proportion(82.7%:83.3%),etc.In general intraoperative conditions,there are statistically significant differences in the extracorporeal circulation time(76.21min±17.80min:120.10min± 49.95min)and the duration of surgery(235.86 min ± 48.81min:258.81 min ± 55.08min)between the OPBCABG and CABG groups.There is no difference in intraoperative blood loss.As for the condition of perioperative recovery and the complications,there are statistically significant differences in the postoperative intubation time(23.26h±7.08h:29.83h± 7.19h),the ICU observing time(1.55 d ± 0.29d:1.83 d ± 0.30d)and the postoperative hospitalization(17.86d±6.55d:21.74d±8.14d).There is no difference in the rate of secondary thoracotomy for hemostasis(6.9%:7.1%),etc.In the data of cardiac Surgery Associated Acute Kidney injury,the incidence of stage I(43.1%:85.7%),the incidence of stage II(34.5%:59.5%)are significantly lower in OPBCABG group and the incidence of stage III is not significantly different.The level of myocardial injury markers(CK-MB,c Tn I,LDH)are different between the two groups.With regard to the long-term prognosis,patients were followed up for three years and the Syntax score and Syntax-Ⅱ score were used for risk stratification.In each risk stratification of the Syntax score and Syntax-Ⅱ,there are no significant discrepancy in the incidence of each clinical endpoint event between the two surgical procedures.With the combination of all the cases,there is no significant difference in the incidence of all clinical end point events under the three risk strata of the Syntax score;there is significant difference in the incidence of all-cause death and myocardial infarction under the three risk strata of the syntax-Ⅱ score(P = 0.001;P = 0.004).Kaplan-Meier survival analysis suggests that there is no statistically significant difference in the survival time of all-cause death event between the OPBCABG group and the CABG group(log-rank test P=0.143)and that there is a statistically significant difference in the survival time of all-cause death event and myocardial infarction event under the three risk strata of the syntax-Ⅱ score(log-rank test P <0.001).Conclusion:1.For patients with left main or three-vessel lesions,on-pump beating coronary artery bypass graft can decrease the intraoperative risk,shorten the intensive care process and reduce the incidence of perioperative cardiac Surgery Associated Acute Kidney injury and the level of myocardial injury.It is a safe alternative for routine consideration.2.With the use of Syntax score and Syntax-Ⅱ score to stratify the patients respectively,regardless of stable angina pectoris patients in low,intermediate,or high-risk,there is no significant difference of long-term prognosis between the two surgical groups.3.The SYNTAX scoring system has poor ability to stratify the risk of all long-term end-point events after coronary artery bypass surgery.The syntax-Ⅱ scoring system is more capable of stratifying the risk of the end-point events of all-cause death and recurrent myocardial infarction,prompting the prognosis of patients in each risk stratification. |
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