Xia Tianyu, Li Bo, Zhang Wei, Wang Zhe, Ye Xiaofeng, Zhou Mi, Li Haiqing, Qiu Jiapei, Zhu Yunpeng, Zhao Qiang
Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiology, Naval Medical Center, Shanghai, China.
Front Cardiovasc Med. 2023 Sep 27;10:1238161. doi: 10.3389/fcvm.2023.1238161. eCollection 2023.
Coronary artery bypass grafting using radial artery grafts (RA-CABG) has improved long-term outcomes. However, major adverse cardiovascular events (MACE-4, including all-cause death, myocardial infarction, stroke, and repeat revascularization) after RA-CABG still occur and the predictors remain uncertain. This study aimed to detect independent risk factors of MACE-4 after RA-CABG.
This is a retrospective case-control study (NCT04935086) conducted among patients who underwent primary isolated RA-CABG between 2009 and 2019 in our center. Baseline characteristics, procedure characteristics, and medication use were compared to identify the independent predictors of MACE-4, all-cause death, and myocardial infarction (MI) with univariate and then multivariate logistic regression.
A total of 370 patients were analyzed using a mean follow-up duration of 48.8 ± 41.0 months. MACE-4, all-cause death, and MI occurred in 102 (27.6%), 27 (7.3%), and 66 patients (17.8%), respectively. Multivariate analysis revealed prior MI (OR = 2.12, 95%CI 1.05-4.25, = 0.04) and RA to the left anterior descending artery (LAD) (non-left internal mammary artery to LAD) (OR = 4.87, 95%CI 1.41-16.82, = 0.01) as independent predictors of MACE-4 after surgery. Female (OR = 4.53, 95%CI 1.06-19.41, = 0.04), left ventricular ejection fraction (LVEF) <40% (OR = 21.00, 95%CI 1.20-368.35, = 0.04), and RA to LAD (OR = 8.55, 95%CI 1.35-54.10, = 0.02) were independent predictors of all-cause death. Prior MI (OR = 3.11, 95%CI 1.40-6.94, = 0.006) emerged as an independent predictor of MI.
Our data suggested that prior MI and RA to LAD were independent predictors of MACE-4 after RA-CABG. Being female, having an LVEF < 40% and RA to LAD indicated death. Prior MI indicated new MI.
使用桡动脉移植物进行冠状动脉旁路移植术（RA-CABG）改善了长期预后。然而，RA-CABG术后主要不良心血管事件（MACE-4，包括全因死亡、心肌梗死、中风和再次血运重建）仍会发生，且预测因素尚不确定。本研究旨在检测RA-CABG术后MACE-4的独立危险因素。
这是一项回顾性病例对照研究（NCT04935086），研究对象为2009年至2019年在本中心接受初次单纯RA-CABG的患者。比较基线特征、手术特征和药物使用情况，通过单因素和多因素逻辑回归确定MACE-4、全因死亡和心肌梗死（MI）的独立预测因素。
共分析了370例患者，平均随访时间为48.8±41.0个月。MACE-4、全因死亡和MI分别发生在102例（27.6%）、27例（7.3%）和66例患者（17.8%）中。多因素分析显示，既往MI（OR = 2.12，95%CI 1.05 - 4.25，P = 0.04）和桡动脉至左前降支动脉（LAD）（非左内乳动脉至LAD）（OR = 4.87，95%CI 1.41 - 16.82，P = 0.01）是术后MACE-4的独立预测因素。女性（OR = 4.53，95%CI 1.0
