Clinical Prognostic Comparison Of Different Revascularization Strategies In Patients With Left Main Artery Disease And Analysis Of Related Influencing Fators

Objective:To investigate the clinical efficacy of left main coronary artery disease after PCI and CABG revascularization strategies,and to investigate independent risk factors of all-cause death and MACCE events within 2 years after PCI(all-cause death,cardiac death,non-fatal myocardial infarction,target vessel Independent risk factors for revascularization,non-fatal cerebrovascular accidents).Methods:A retrospective study of 321 patients with left main coronary artery disease who underwent PCI or CABG surgery at the Department of Cardiology,Cardiology Center,First Hospital,Jilin University from January 1,2013 to December 31,2015 was performed.Baseline data such as patient's gender,age,Syntax score,NERS II score,creatinine,leukocyte,troponin I,and surgery status,and 2-year follow-up results were collected and grouped or subgrouped according to different revascularization strategies and Syntax scores.Comparative analysis of the prognosis of each group.Logistic regression analysis was used to analyze the independent risk factors of all-cause mortality and MACCE events in patients with left main coronary artery disease.The primary endpoints of the study included all-cause deaths,cardiac death,non-fatal myocardial infarction,target vessel revascularization,non-fatal cerebrovascular accidents,and MACCE events.Secondary endpoints included heart failure readmission,gastrointestinal bleeding.Reasults:A total of 363 patients were enrolled in this study,including 256 in the PCI group and 107 in the CABG group.Patients were followed up for 2 years.30 patients with incomplete baseline data were excluded and 12 patients were lost(3.3%).A total of321 patients completed the follow-up and had complete data,including 225 cases of PCI group,96 cases of CABG group.The age of patients in the CABG group was larger than that in the PCI group(65±8 years vs.62±11 years,P=0.009<0.050),and the difference was statistically significant.In terms of Syntax scores,the CABG group had less than 22 points of composition and more than 32 points,and the PCI group had 22 to 32 points.The difference was statistically significant(25.3% vs 7.3%,43.1% vs 36.5).%,31.6% VS56.3%,P=0.000<0.050).The length of stay in the CABG group was significantly longer than in the PCI group,with a statistically significant difference(7(6-9)VS21(14-29),P=0.000<0.050).Fasting plasma glucose,platelet count,absolute mononuclear cells,and creatine kinase isoenzymes were significantly higher in the PCI group than in the CABG group(6.29(5.15-8.05)vs 5.78(5.10-6.82),P=0.021<0.050;218.72(182.00-256.00)VS 203.50(162.50-228.75),P = 0.011 <0.050;0.42(0.32-0.54)VS 0.39(0.31-0.48),P = 0.046 <0.050;1.86(0.81-13.90)VS 1.33(0.67-3.43),P=0.012<0.050).There was no statistically significant difference in the baseline data.Analysis of the event-free survival curves of the PCI group and the CABG group found that the risk of cardiogenic death in the CABG group was 2.746 times that of the PCI group(HR = 2.746,P = 0.003 <0.050),and the difference was statistically significant.The death risk was 1.816 times that of the PCI group(HR=1.816,P=0.052>0.050),but it was not statistically significant.This may be related to the age of older patients in the CABG group and the high-to-moderate risk of the Syntax score.The Syntax score subgroup analysis showed no statistically significant differences between the primary endpoint events and secondary endpoint events in each subgroup.Multivariate logistic regression analysis of cardiac troponin I,total cholesterol,white blood cells,creatine kinase isoenzymes,CK-MB,Syntax scores,NERS II scores,etc.revealed cardiac function class IV/Killip class IV,NERS II score > 19 points,Euro SCORE score,albumin,creatinine,fasting blood glucose,and monocyte absolute value were independent risk factors for all-cause mortality and MACCE events after PCI for left main coronary artery disease.Conclusion:1.For patients with left main coronary artery disease,there was no significant difference in the clinical efficacy of PCI and CABG for two different revascularization strategies.PCI is an option for revascularization in addition to CABG.2.Heart function grade IV/Killip grade IV grade,NERS II score> 19 points,albumin,creatinine,fasting blood glucose,and monocyte absolute value are independent risk factors for predicting all-cause mortality after PCI in left main disease.3.Cardiac function grade IV/Killip grade IV,NERS II score>19,Euro SCORE score,and creatinine are independent risk factors for predicting MACCE events after PCI in patients with left main coronary artery disease.