Analysis Of Prognostic Factors Of Cardiopulmonary Bypass-assisted Coronary Artery Bypass Grafting In Ischemic Cardiomyopathy

Objective:The prognostic factors affecting the poor prognosis of coronary artery bypass grafting in the treatment of ischemic cardiomyopathy under cardiopulmonary bypass were analyzed.Methods:A retrospective analysis was performed for 58 patients with ischemic cardiomyopathy(ICM)who visited the Department of Cardiac Surgery of the First Hospital of Jilin University from January 01,2020 to November 30,2022.They were grouped according to whether the improvement in ejection fraction(EF)exceeded 10%,and were divided into case groups(EF improvement <10%)and control groups(EF improvement ≥10%).Using the nested casecontrol study method,Gen Match reproducible 1:1 matching was performed with the same surgeon and similar operation time(<3 months),a total of 116 cases(58 cases in the case group and 58 cases in the control group)were matched,and then through propensity matching analysis,according to the 1:2 frequency matching,a total of 42 ICM patients(14 cases in the case group and 28 cases in the control group)were matched.Statistics of general clinical data,preoperative related data,intraoperative and postoperative related data.In Empower Stats4.1software,the difference between the two groups of patients was analyzed using methods such as t-test or Mann-Whitney U-test,chi-square test,or Fisher exact probability.At the same time,taking the last cardiac ultrasound time of patients in the cut-off case system as the follow-up node,univariate COX regression was used to analyze the correlation between the relevant indicators and the therapeutic effect of extracorporeal bypass-assisted coronary artery bypass grafting(CABG)on patients with ICM.After comprehensive screening by combining hypothesis testing and regression analysis,the filtered variance indicators are incorporated into multiple regression models to determine whether there is a stable linear correlation,and the ROC curve is used to determine the best cut-off value of the continuous variable.Finally,the difference indexes with stable linear relationship were analyzed by multivariate,and the influencing factors were screened by the regression method,and finally the independent prognostic factors of the adverse prognosis of CABG in patients with ICM under cardiopulmonary bypass(bilateral P<0.05 was statistically significant).Results:1.In univariate analysis,compared with the control group,the proportion of patients in the case group who underwent coronary stent implantation was higher(P=0.018,P*=0.051),the content of N-terminal B-type natriuretic peptide precursor(NT-pro BNP)was higher(P<0.001,P*<0.001),the proportion of combined ventricular aneurysms was higher(P=0.005,P*=0.014),the extracorporeal circulation time was longer(P=0.015,P*=0.021),the aortic occlusion time was longer(P=0.040,P*=0.041),the operation time was longer(P=0.035,P*=0.016),and the dosage of various blood products was higher(P<0.05).2.The inclusion of variance indicators in univariate analysis into multiple regression models showed a stable linear correlation between aneurysm,NT-pro BNP level,and operation time.3.Through ROC diagnostic association analysis,the optimal cut-off value of NT-pro BNP level was 1515 pg/ml(accuracy = 0.74,specificity = 0.79,sensitivity = 0.64),the optimal cutoff value of operation time was 4.46 h(accuracy = 0.67,specificity = 0.71,sensitivity = 0.57),and the continuous variables were grouped according to the best cut-off value and then included in univariate COX regression to plot the forest plot.4.The results of multivariate COX regression analysis showed that NT-pro BNP>1515pg/ml(HR=3.58;95%CI=1.03-12.44;P=0.044)and operation time >4.46 hours(HR=10.31;95%CI=1.19-89.51;P=0.034)were associated with the adverse prognosis of patients with ICM treated with CABG assisted by cardiopulmonary bypass.Conclusion:1.Patients with poor prognosis of ICM treated with CABG under cardiopulmonary bypass had significantly more blood products used during hospitalization than patients with good prognosis.2.NT-pro BNP>1515pg/ml and operation time >4.46 hours were independent prognostic factors for the adverse prognosis of patients with ICM treated with CABG under cardiopulmonary bypass.