| ObjectiveTo investigate the clinical features and prognosis of coronary artery bypass grafting(CABG)in patients with acute anterior wall STEMI and acute inferior wall STEMI.MethodsData of 223 patients who underwent CABG in Beijing Anzhen hospital was collected retrospectively from January 2016 to January 2021,and they were divided into acute anterior STEMI group(n=114)and acute inferior STEMI group(n=109).The patients were divided into the anterior wall group(A,B,C)and the inferior wall group(D,E,F)according to the operative intervals(7-14 days,15-30 days,31-60 days).Outcome indicators included patients’ general information,preoperative LVEF,left main stem disease>50%,multiple vessel disease(more than 3 vessels),KillipⅢ/ Ⅳ,IABP before CABG,etc.Intraoperative and postoperative indicators included surgical method,surgery time,the number of grafts,ICU length of stay,the duration of ventilatory support,the postoperative length of stay;Preoperative and postoperative levels of c Tn I;Postoperative complications included secondary thoracotomy operation,perioperative myocardial infarction,ventricular fibrillation,cardiac arrest,acute kidney injury,acute liver injury,low cardiac output syndrome,and death.Postoperative follow-up was conducted for 1 month to 5 years,and the end points were MACCE(recurrence angina,acute myocardial infarction,ischemic stroke,heart failure,and PCI).Kaplan-Meier curves were drawn and the differences between the groups were compared.ResultsAmong groups A,B and C,preoperative LVEF(group A 50.32±5.29;Group B 52.97 ±3.99;Group C 53.87±3.76,P < 0.05),preoperative use of IABP(group A 7 cases;Group B,4cases;4 cases in group C,P < 0.05),operation time(group A 277.50±71.97;Group B242.63±39.23;Group C 238.06±54.50,P < 0.05)min,postoperative ICU residence time(group A 47.50±17.26;Group B 29.55 ± 15.01;Group C 27.98±12.63,P < 0.05)h,postoperative hospitalization time(group A 8.14±1.58;Group B 6.47 ± 2.12;Group C 5.93±1.77,P < 0.05)d,postoperative troponin(group A 5.404±2.499;Group B 3.466±1.837;Group C was3.809±2.825,P < 0.05)ng/ml,and the difference was statistically significant.There was no statistical difference in indicators among D,E and F groups.In group A and D,preoperative LVEF(50.32±5.29 in group A and 53.52±3.22 in group D,P < 0.05)and preoperative IABP(7cases in group A;3 cases in group D,P < 0.05),operation time(group A 277.50±71.97;Group D 238.40±37.93,P < 0.05)min,postoperative ICU residence time(group A 47.50±17.26;Group D 33.32±16.34,P < 0.05)h,postoperative hospital stay(group A 8.14±1.58;D group 6.36±1.19,P < 0.05)D,c Tn I on the first day after surgery(group A 5.404±2.499;Group D 3.538±2.154ng/ml,P < 0.05)c Tn I on the second day after surgery(group A 3.263±1.490;2.221±0.808 in group D,P < 0.05)ng/ml,there was statistical difference;There was no statistical difference in the indicators between group B and group E,and between group C and group F.After 1 month to 5 years of follow-up,MACCE was used as the end point of the study,and there was no statistical difference between the groups.ConclusionCABG was performed between 7days and 14 days after acute anterior wall STEMI,which did not increase operative mortality,but added the recovery time and surgery complications,which should be paid more attention in clinical practice.If the patient’s condition is stable,CABG surgery is recommended 2 weeks later to reduce postoperative complications.Patients with acute inferior wall STEMI underwent coronary artery bypass surgery between 7 and 60 days,and there was no statistic difference.CABG surgery within 7-14 days after acute STEMI,inferior wall infarction have a better prognosis than anterior wall infarction. |
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