Analysis Of Angiographic Characteristics And The Risk Factor After Coronary Artery Bypass Grafting In Patients With Recurrent Angina

Objectives:To analyze the baseline characteristics and coronary angiographic characteristics of the patients who underwent CABG with recurrent angina; Analyse the risk factors leading to the lesion of grafts by the above characteristics; To discuss the effects between conservative medical treatments interventional treatment in the native coronary artery and interventional treatment in the grafts according to the clinical following-up of MACE; Analyse the risk factors leading to the MACE after treatment of lesion of graft.Methods:A retrospective analysis of baseline characteristics> coronary angiographic characteristics and information of CABG surgery of744patients who underwent CABG with recurrent angina from August2005to April2012in Tianjin Thoracic Hospital; Analyse the risk factors leading to the lesion of grafts by the above characteristics; To discuss the effects between conservative medical treatment> interventional treatment in the native coronary artery and interventional treatment in the grafts, according to the clinical following-up of MACE (including death, nonfatal myocardial infarction,target lesion revascularization) in April2012; According to the follow-up results of MACE divide the entirety into group MACE and group none MACE,conclude the independ risk factors which leading to the MACE after treatment to lesion of graft through Cox regression analysis; Analysis the survival rate of conservative medical treatment, interventional treatment in the native coronary artery and interventional treatment in the grafts by Kaplan-Meier survival curve.Results:(1) There were significant differences between rates of lesion in IMA, SVG and RA (40.0%vs36.0%vs.20.1%,P<0.01).(2) There were significant differences between rates of lesion in different target vessel of SVG:RCA)> LCX> PLV>PDA>IMB>Diag>OM>LAD (48.7%vs39.2%vs37.6%vs36.3%vs33.3%vs33.2%vs33.0%vs31.9%, p<0.05).(3) There were significant differences in the position of different grafts:there were significant differences in rate of the distal anastomatic lesions between LIMA and SVG (68.9%vs39.6%,p<0.01); there were significant differences in rate of the distal anastomatic subtotal occlusion-occlusion and the body subtotal occlusion-occlusion between LIMA and SVG.(the distal anastomatic:79.6%vs51.7%, p<0.01; the body:20.4%vs26.0%, p<0.01).(4) There were significant differences in rates of lesion of LIMA and SVG between on-pump CABG and off-pump CABG.(LIMA group:13.5%vs25.1%,p<0.01; SVG group:31.0%vs39.8%, p<0.01).(5) There were significant differences of rates of lesion in the different degree of lesion of target vessel before CABG; LIMA lesion rate of70%group>71-80%>81-90%>91-99%>100%(34.4%vs26.6%vs21.0%vs16.8%vs12.8%, p<0.01);SVG Iesion rate of70%group>71-80%>91-99%>81-90%>100%(48.0%vs41.3%vs35.1%vs34.3%vs33.0%, p<0.01).(6) There are significant differences in rate of lesion with target vessel diameter>2.0mm and lesions with target vessel diameter<2.0mm between LIMA and SVG.(LIMA group:24.8%vs16.0%, p<0.05; SVG group:40.0%vs32.6%, p <0.01).(7) There are significant differences in rate of lesion between the independent SVG,the sequential SVG and the "Y" composite SVG (64.6%vs72.1%vs77.8%, p<0.05).(8) There were significant differences in rate of lesions between the different years of SVG and LIMA. The lesion rate of LIMA: greater than10years group> group less than1year>1-5years group>6-10years(35.7%vs28.6%vs18.7%vs14.2%, p<0.05; The lesion rate of SVG Group:less than1year group>1-5years group>6-10years group>10years group (90.2%vs43.4%vs32.8%vs31.1%, p<0.01).(9)In simple risk factors of lesion of graft:there were significant differences in the rate of hypertension (60.3%vs68.5%, p<0.05), diabetes (39.1%vs49.7%p<0.01),and smoking (42.0%vs55.6%, p<0.01), LP (a)(0.31±0.20mmmo/L VS0.39±0.27mmol/L, p<0.01), VLDL (0.92±0.38mmol/Lvs1.08±0.45mmol/L,p<0.01), HDL (1.15±0.31mmol/L vs1.01±0.29mmol/L,p<0.01), TIBL (14.25±2.36mmol/L vs11.70±4.48mmol/L, p<0.05)、aortic systolic flow velocity (1.35±0.56mm/S vs1.22±0.33mm/S, p<0.01) between the patency SVG group and the diseased SVG group.(10) The logistic regression analysis showed:The hypertension, diabetes, LP (a) and VLDL were risk factors of SVG lesions, while HDL was the protective.(11)There were significant differences in rate of MACE (61.8%vs30.5%vs21.0%, p<0.01) nonfatal myocardial infarction(MI)(20.6%vs9.2%vs6.7%, p<0.01) and target lesion revascularization(TLR)(20.6%vs9.2%vs6.7%, p<0.01) between the conservative medical treatment group、the interventional treatment in the native coronary artery group and interventional treatment in the grafts group.(12)There were significant differences in survival rate of no-MACE (69.5%vs79.0%vs38.2%, p<0.001), no-MI%(90.8%vs93.3%vs79.4%, p=0.001)and no-TLR(83.4%vs88.2%vs67.1%, p=0.001),and no significant differences in survival rate of no-death (94.4%vs97.5%vs91.8%, p=0.130)(13) The Cox analysis regression showed:LP (a) and VLDL were risk factors of MACE after treatment to lesion of graft, while HDL was the protective factors.Conclusion:(1).There was a higher rate of lesions in LIMA than that of SVG. There was a higher rate of lesions in SVG with target vessel which is located in front of the heart There was a higher rate of lesions in SVG which is connected with the branch vessel of Coronary artery.(2) In LIMA and SVG the position of the lesion is more likely to occur in the distal anastomosis.(3) There was a higher rate of lesions in LIMA and SVG under on-pump CABG than off-pump CABG; The degree of lesion of target vessel is more severe, the rate of lesion of grafts is more lower。There was a higher rate of lesions with target vessel diameter<2.0mm than≥2.0mm between LIMA and SVG. There was a higher rate of lesions in SVG which is connected multiple-distal targets than single-distal target.(4) The rate of lesion of LIMA and SVG is the highest at1year after CABG.Thereafter the rate of lesion of LIMA is little change.(5) Hypertension, diabetes, LP (a) and VLDL were risk factors of SVG lesions,while HDL was the protective.(6) LP (a) and VLDL were risk factors of MACE after treatment to lesion of graft,while HDL was the protective factor.