Factors Associated With Poor Prognosis After Coronary Artery Bypass Grafting In Patients With Coronary Heart Disease With Low Ejection Fraction

Objective: By comparing whether composite events occurred after coronary artery bypass grafting(CABG)in patients with coronary atherosclerotic heart disease(CHD)with low ejection fraction,to compare the preoperative and intraoperative influencing factors which may affect the occurrence of compound events between the two groups of patients,and to explore the risk factors affecting prognosis.Methods: The clinical data of 129 patients with coronary heart disease with low ejection fraction(≤40%)who underwent CABG surgery in the Department of Cardiac Surgery of Qingdao Municipal Hospital from January 2017 to October 2021 were retrospectively analyzed.Postoperative death or major adverse cardiac and cerebrovascular events(MACCE)were defined as composite events,and were grouped according to whether composite events occurred.Group A: no composite events occurred;group B:composite events occurred.The clinical data,intraoperative and postoperative data of the two groups of patients were compared and analyzed,and additional analysis of postoperative MACCE and other complications was performed.SPSS 26.0 statistical software was used for statistical analysis of data,Graph Pad Prism 7.0 software was used for data visualization and drawing,Logistic regression was used to analyze compound events and their risk factors,and ROC curve was used to evaluate diagnostic value.P<0.05,the difference was statistically significant.Results: There were significant differences in recent myocardial infarction,preoperative renal decompensation,left main stenosis,surgical nature,cardiopulmonary bypass time,preoperative hemodynamic status,postoperative renal failure,pneumonia,and mechanical ventilation use time between the two groups(P<0.05).Logistic univariate regression analysis showed that recent myocardial infarction(OR: 2.469,95%CI: 1.865-2.908,P=0.037),preoperative renal decompensation(OR: 4.526,95%CI: 1.357-11.206,P=0.029),left main artery stenosis(OR: 1.740,95%CI: 1.523-2.608,P=0.048),emergency surgery(OR: 1.675,95%CI: 1.481-1.967,P=0.009),preoperative hemodynamic status(OR:5.423,95%CI: 1.259-14.386,P=0.003)and postoperative renal failure(OR: 1.614,95%CI:1.075-1.928,P=0.017)were associated with the occurrence of composite events.Meanwhile,additional univariate regression analysis showed that preoperative renal decompensation(OR: 1.943,95%CI: 1.687-3.246,P<0.001),emergency surgery(OR:3.459,95%CI: 1.498-5.991,P=0.019),preoperative hemodynamic status(OR: 1.266,95%CI: 1.041-1.482,P=0.046),and postoperative renal failure(OR: 1.254,95%CI: 1.007-1.458,P=0.025)were associated with postoperative MACCE.Diabetes mellitus(OR: 1.389,95%CI: 1.054-3.660,P=0.008),preoperative renal decompensation(OR: 1.539,95%CI:1.016-1.959,P=0.046),history of dialysis(OR: 2.207,95%CI: 1.147-3.328,P=0.027),and emergency surgery(OR: 3.580,95%CI: 1.117-5.562,P<0.001)were also associated with postoperative renal complications.Logistic multivariate regression analysis showed that preoperative renal decompensation(OR:1.611,95%CI:1.209-1.935,P=0.006),preoperative hemodynamic instability(OR: 4.067,95%CI: 1.591-9.649,P<0.001)and postoperative renal failure(OR: 2.354 95%CI: 1.258-6.217,P<0.001)were independent risk factors for composite events.Emergency surgery was associated with postoperative MACCE(OR:2.186,95%CI: 1.039-5.567,P=0.031)and postoperative renal complications(OR: 5.732,95%CI: 1.170-10.796,P=0.002).Diabetes(OR: 2.683,95%CI: 1.172-6.533,P=0.030)is also associated with postoperative renal complications.Conclusion:1.After CABG in patients with coronary heart disease with low LVEF,preoperative hemodynamic instability,Preoperative renal decompensation,and postoperative renal complications were independent predictors of composite events within 30 days after surgery,increasing postoperative Risk of death within 30 days.2.Patients with low LVEF coronary heart disease undergoing emergency surgery had an increased incidence of postoperative MACCE and postoperative renal complications.Therefore,in patients with low EF,the focus is not on the choice between on-pump and offpump,the assessment of viable myocardium is more important.Surgical intervention before the appearance of pathological Q waves in the preoperative ECG,and timely postoperative dialysis in patients with poor renal function has a better effect and can reduce mortality.Coronary angiography showing incomplete occlusion of coronary arteries;Good collateral circulation or visible reverse blood flow;meticulous surgical technique and revascularization before hemodynamic deterioration are important strategies to minimize30-day mortality-related factors and improve surgical outcomes.