| Objectives:Through the prospective analysis of baseline clinical data,laboratory biochemical indicators,coronary angiographic characteristics and basic information of previous CABG in patients who underwent CABG with recurrent angina, To observe the coronary angiographic features of SVG bridge in patients with chest pain after CABG;Analysis the risk factors for the late SVG bridge lesions.Methods: By prospective analysis of baseline clinical data, laboratory biochemical indicators, coronary angiographic characteristics and situation of previous CABG of 181 patients who underwent CABG with recurrent angina from March 2015 to January 2016 in Tianjin Chest Hospital. Collecting the blood specimen of patients to establish the sample library, Using ELISA to detect the concentration of CRP-HS, IL-6,PDGFB and Adropin.To discuss the coronary angiographic features of SVG bridge, Analysis the risk factors for the late SVG bridge lesions.Results: 1.The features of SVG bridge(1) The rates of lesion among the different target vessel of SVG bridge from high to low:SVG-IMB(100.0%)>SVG-RCA(72.2%)>SVG-LCX(71.8%)>SVG-PLV(66.7%)>SVG-OM( 58.6%)>SVG-Diag(56.9%)>SVG-PDA(52.0%)>SVG-LAD(50.8%). The difference is statistically significant in rates of lesion in different target vessel of SVG bridge, P<0.05;(2) The rates of lesion among the different parts of SVG bridge from high to low: the distal anastomatic(31.1%)>the proximal anastomatic(16.8%)> the body(10.3%). The difference is statistically significant in rates of lesion in the different parts of SVG bridge, P<0.05;(3) Analysis the rates of lesion which was influenced by different ways of anastomosis: The rates of lesion from high to low:Single anastomose(58.6%)> Sequential anastomose(53.8%)>“Y” composite anastomose(50.0%).But there were no statistically significant in the rates of lesion which was influenced by different ways of anastomosis, P>0.05;(4) Study on the different preoperative target vessel diameter on the rates of lesion of the SVG Bridge: The rates of lesion: Target vessel diameter < 2.0 mm group> Target vessel diameter?2.0 mm group(25.5%vs20.2%,P>0.05).There were no statistically significant, P>0.05;(5) Study on the different preoperative target vascular stenosis degree on the rates of lesion of the SVG Bridge:The rates of lesion from high to low :<70%(100%)>71-80%(75.4%)>81-90%(49.6%)>91-99%(46.4%)>100%(34.3%). The difference is statistically significant,P<0.05;(6) Analysis the influence of different bridge ages for the rates of lesion of SVG bridge: The rates of lesion from high to low:less than 1 year group(78.7%)>more than 10 year group(57.3%)>6-10 year group(56.1%)>1-5 year group(46.2%).The difference is statistically significant,P<0.05. 2.The risk factors for the late SVG bridge lesions(1) CHD type(SVGD group was in order to focus on UAP and NSTMI, no-SVGD group was in order to focus on SAP)?numbers of diseased coronary?arteries before CABG(SVGD group was in order to focus on triple vessel disease)?numbers of SVG bridge(the number of SVG bridge in SVGD group was four vessels,the number of SVG bridge in no-SVGD group was one vessel)?age(66.00±8.16 vs 69.03±6.84,P<0.05)?age of CABG(66.00±8.16 vs 69.03±6.84,P<0.05)?TG(1.94±1.09vs1.58±0.49,P<0.05)?Lp(a)(43.7(14.70,117.00vs19.40(8.30,41.95),P<0.05)and APOB(1.02±0.33vs0.89±0.21,P<0.05)was statistically significant in SVGD group and no-SVGD group;(2)The level of RDW(12.32±0.89vs12.02±0.52,P<0.05)?NLR(3.40±2.11 vs 2.75±0.82, P<0.05) and PLR( 143.10±54.70vs124.57±34.40, P<0.05) were statistically significant in SVGD group and no-SVGD group;(3)The level of CRP( 36.94±14.17vs36.78±18.00, P>0.05) ? IL-6(42.13±18.04vs47.21±22.70,P>0.05)and Adropin(3.03±2.86vs5.48±3.24, P>0.05) were no statistically significant in SVGD group and no-SVGD group; The level of PDGFB in SVGD group was significantly higher than no-SVGD group,(228.27±85.35vs193.37±60.63,P<0.05);(4)The degree of anastomotic proximal stenosis(84.59±10.22vs87.27±7.78, P<0.05) ? diameter of target vessel(1.79±0.40vs2.04±0.31,P<0.05)and the type of target vessel(SVGD group was in order to focus on LCX and RCA, no-SVGD group was in order to focus on LAD and Diag)were statistically significant in SVGD group and no-SVGD group;(5) Analysis risk factors of effecting the late SVG bridge lesions: the number of SVG bridge >2?LDL>3.49 mmol/L?RDW>12.75%?NLR>3.34?PDGFB>308.81 pg/ml and PCT>0.185 were risk factors of the late SVG bridge lesions.(6)Preliminary established a model of risk prediction score system of SVGD: According to the partial regression coefficient of variables from logistic regression analysis give them a value: the number of SVG bridge >2:1.5 minute;?LDL>3.49 mmol/L:1.5 minute;?RDW>12.75%:2.5 minute;NLR>3.34:1.5 minute;?PDGFB>308.81pg/ml:2.5 minute;PCT>0.185:1.0 minute.Conclusion:(1) The rate of lesion of SVG bridge which was coincided to LAD was significantly lower than those which was coincided to LCX or RCA;(2) The rate of lesion of the distal anastomatic of SVG bridge was the highest, The rate of lesion of the proximal anastomatic take second place, The rate of lesion of the body of SVG bridge was the lowest;(3) Preoperative target vascular stenosis degree is heavier,the rate of lesion of SVG bridge is lower;(4)There was a higher rate of lesion in the less than 1 year group, The rate of lesion of SVG bridge with the extension of the bridge of age showed a trend of increasing after 1year.(5) The number of SVG bridge >2?LDL>3.49 mmol/L?RDW>12.75%?NLR>3.34?PDGFB>308.81pg/ml and PCT>0.185 were risk factors of the late SVG bridge lesions;(6)Preliminary established a model of risk prediction score system of SVGD: the number of SVG bridge >2:1.5minute; LDL>3.49 mmol/L:1.5minute;RDW> 12.75%:2.5minute;NLR>3.34:1.5minute; PDGFB>308.81pg/ml:2.5minute; PCT>0.185:1.0minute. |
PDF Full Text Request