| Objective:This study aims to investigate the impact of coronary artery bypass grafting guided by myocardial ischemia on the prognosis of patients with coronary heart disease.Method:A total of 205 patients with coronary heart disease who underwent CABG in our hospital from Jan 2016 to Jan 2018 were selected.These patients were divided into myocardial ischemia guidance group and coronary anatomy guidance group.94 cases of coronary artery bypass grafting under the guidance of myocardial ischemia(including 22 cases of fractional flow reserve guidance,43 cases of cardial magnetic resonance imaging guidance,and 29 cases of myocardial contrast echocardiography guidance);111 cases of coronary artery bypass grafting under the guidance of coronary anatomy(guided by coronary angiography).We collected clinical data of all patients and followed up their postoperative survival status,including cardiac color Doppler ultrasound-related indicators(left ventricular ejection fraction,left ventricular end-diastolic diameter,heart index),angina pectoris,heart failure,all-cause mortality,cardiac mortality.The t-test or χ2 test was used to compare the surgical results and prognosis of coronary heart disease patients in the myocardial ischemia guidance group and the coronary anatomy guidance group,and the Kaplan-Meier curve was used to describe the survival curve and perform survival analysis.Results:In this study,205 patients were followed up with an average follow-up time of(47.6±14.2)months.All-cause mortality:4 cases(4.3%)in the myocardial ischemia guidance group,11 cases(9.9%)in the coronary anatomy guidance group.cardiac mortality:3 cases(3.2%)in the myocardial ischemia guidance group,9 cases(8.1%)in the coronary anatomy guidance group.One year after surgery,it was found that the average LVEF of the myocardial ischemia guidance group was(57.2±5.7%vs 47.2±7.8%)higher than that of the coronary anatomy guidance group,and the difference was significant(P<0.001);the former had an average LVDD(53.1±6.5mm vs 55.9±7.3mm,P=0.006),the average CI(3.5±0.5L/min/m2 vs 3.2±0.6L/min/m2,P=0.006)improved significantly.Five years after the follow-up,the incidence of angina(18%vs 28%,P=0.046)and heart failure(5%vs 13%,P=0.031)in the myocardial ischemia guidance group was lower than that in the coronary anatomy guidance group,with significant differences;The incidence of revascularization in the myocardial ischemia guidance group was higher than that in the coronary anatomy guidance group,and the difference was not statistically significant(3%vs 2%,P=0.532).The NYHA classification of the two groups was followed up for 3 years,and it was found that the myocardial ischemia guidance group was lower than the coronary anatomy guidance group(2.1±0.4 vs 2.3±0.7,P=0.003),and the difference was significant.During the 5-year follow-up,15 cases died from all causes,and 12 cases died from cardiac cause.From the analysis of survival rate,it is found that the survival rate of the myocardial ischemia guidance group is higher than that of the coronary anatomy guidance group(96%vs 89%).With cardiogenic death as the end event,the myocardial ischemia guidance group is higher than the coronary anatomy guidance group(96%vs 91%),but the difference was not statistically significant(P>0.05).There was a significant difference in the incidence of secondary thoracic exploration due to hemostasis between the myocardial ischemia guidance group and the coronary anatomy guidance group(0%vs 5.4%,P=0.032).Conclusion:1.Assessing myocardial ischemia and guiding CABG to improve the prognosis of patients with coronary heart disease has advantages over assessing coronary anatomical stenosis;2.A comprehensive assessment of the degree of myocardial ischemia and comprehensive consideration of the diseased coronary plaque load can reduce the rate of incomplete revascularization and retain the unique advantages of CABG in preventing myocardial infarction. |
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