Risk Factors for Adverse Events in Patients after Coronary Endarterectomy
甄健帆 1刘杰 2彭金星 3蒋卓航 3木合太江·土尔地 1宋佳豫 3骆翔 1陈泽锐 1孙图成1
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作者信息
1. 广东省心血管病研究所 广东省人民医院(广东省医学科学院),广州 510100
2. 南方医科大学珠江医院,广州 510100
3. 南方医科大学附属广东省人民医院(广东省医学科学院),广州 510100
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摘要
目的 探究复杂冠状动脉(冠脉)粥样硬化性心脏病(冠心病)患者行冠脉内膜剥脱联合冠脉旁路移植术(coronary endarterectomy and coronary artery bypass grafting,CE-CABG)后发生主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular event,MACCE)的独立危险因素.方法 回顾性分析广东省人民医院2016年7月至2024年4月期间96例行CE-CABG患者的临床资料.通过单因素分析和二元Logistic回归分析确定CE-CABG术后发生MACCE的独立危险因素,最后通过受试者工作特征曲线(receiver operating characteristic curve,ROC)评价危险因素的预测效能.结果 MACCE组15例,非MACCE组81例.4例在围术期死亡,3例在随访期间死亡,5例失访.随访期间,CE-CABG患者术后MACCE累计发生率为15.6%.单因素回归分析发现,MACCE组和非MACCE组间比较,差异有统计学意义的指标有年龄(P=0.043),左前降支剥脱(P=0.017),出血再手术(P=0.004),术后血红蛋白最低值(P=0.024).二元Logistic回归分析结果显示,左前降支剥脱(OR=10.876,95%CI:1.250～94.651,P=0.031)、出血再手术(OR=41.395,95%CI:2.511～682.38,P=0.009)是CE-CABG患者术后发生MACCE的独立危险因素.ROC分析结果显示Logit(P)(联合预测概率)的曲线下面积为 0.866(95%CI:0.784～0.948),有统计学意义(P<0.001).结论 左前降支剥脱和术后因出血再手术的CE-CABG患者术后发生MACCE的风险更大.
Abstract
Objectives To investigate the independent risk factors for major adverse cardiovascular and cerebrovascular events(MACCE)after coronary endarterectomy and coronary artery bypass grafting(CE-CABG)in patients with complex coronary artery disease.Methods A retrospective analysis was conducted on the clinical data of 96 patients who underwent CE-CABG in Guangdong Provincial People's Hospital from July 2016 to April 2024.Univariate analysis and binary Logistic regression analysis were used to determine the independent risk factors for MACCEs after CE-CABG,and finally,the predictive efficacy of risk factors was evaluated by the receiver operating characteristic curve(ROC).Results Four patients died during the perioperative period,3 patients died during the follow-up period,and 5 patients were lost to follow-up.The cumulative incidence rate of MACCEs after CE-CABG was 15.6%during the follow-up period.Univariate regression analysis showed that there were statistically significant differences between MACCE group and non-MACCE group in age(P=0.043),left anterior descending artery(LAD)endarterectomy(P=0.017),reoperation for bleeding(P=0.004),and the lowest postoperative hemoglobin value(P=0.024).Binary Logistic regression analysis showed that LAD endarterectomy(OR=10.876,95%CI:1.250-94.651,P=0.031)and reoperation for bleeding(OR=41.395,95%CI:2.511-682.38,P=0.009)were independent risk factors for MACCEs after CE-CABG.The ROC results showed that the area under the curve of Logit(P)(combined predictive probability)was 0.866(95%CI:0.784-0.948),which was statistically significant(P<0.001).Conclusions Patients who underwent LAD endarterectomy and reoperation for bleeding after CE-CABG are at a greater risk of MACCEs postoperatively.
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