冠状动脉旁路移植术后二级预防措施与左乳内动脉桥血管病变相关性研究

Correlation between secondary prevention measures after coronary artery bypass grafting and lesions of left internal mammary artery

目的:分析冠状动脉旁路移植术(CABG)后二级预防措施及其与左乳内动脉(LIMA)桥血管病变的相关关系。方法:回顾性收集2015年1月至2019年12月,北京安贞医院因再发胸痛住院的CABG术后患者。通过电子病历系统提取患者基本信息、二级预防用药、胆固醇、空腹血糖、血压以及冠状动脉造影结果。结果:共纳入研究对象331例,男性269例(81.3%),女性62例(18.7%)。CABG后持续吸烟者37例(24.8%);具有高血压病史者218例(65.9%)、糖尿病病史者125例(37.8%);LDL-C<1.8mmol/L者144例(43.5%)。左乳内动脉桥血管病变91例(29.2%),其中局限性病变占50.5%,完全闭塞性病变为45.1%。服用他汀类药物者LIMA桥血管病变率低于未服用他汀者(22.3%vs.38.3%,χ^(2)=9.292,P=0.002)。CABG术后吸烟状态与LIMA桥血管病变有相关关系(χ^(2)=7.219,P=0.027)。多因素Logistic回归分析结果显示,CABG术后仍然吸烟者LIMA桥血管发生病变的风险增加(OR=2.528,95%CI:1.167~5.478),而CABG术后戒烟和从不吸烟的患者LIMA桥血管发生病变的风险,差异无统计学意义(OR=0.947,95%CI:0.514~1.746)。服用他汀类药物LIMA桥血管发生病变的风险降低(OR=0.402,95%CI:0.235~0.687)。结论:CABG后再发胸痛患者LIMA桥血管病变发生率为27.5%,术后戒烟以及服用他汀类药物与降低LIMA桥血管病变发生的风险有关。

Objective:To analyze the correlation between secondary prevention measures after Coronary Artery Bypass Grafting(Coronary Artery Bypass Grafting,CABG)and Lesions of LIMA(Left Internal Mammary Artery,LIMA).Methods:Patients with recurrent chest pain after CABG from January 2015 to December 2019 in Beijing Anzhen Hospital were retrospectively collected.Basic information,pharmacotherapy,results of cholesterol,fasting blood glucose,blood pressure and coronary angiography were retrieved from the electronic medical record system.Results:A total of 331 subjects were included,including 269 males(81.3%)and 62 females(18.7%).37 patients(24.8%)continued smoking after CABG;218(65.9%)had history of hypertension and 125(37.8%)had history of diabetes.144 patients(43.5%)had low density lipoprotein cholesterol<1.8mmol/L.91 cases(29.2%)had left internal mammary artery bridging lesion,of which 50.5%had local lesion and 45.1%had total occlusion.The LIMA vascular lesion rate was lower in those taking statins than in those not taking statins(22.3%vs.38.3%,χ^(2)=9.292,P=0.002).Smoking status after CABG was significantly correlated with LIMA bridge vascular lesions(χ^(2)=7.219,P=0.027).The risk of LIMA bridge vascular lesion increased in smokers after CABG(OR=2.528,95%CI:1.167-5.478).There was no significant difference in the risk of LIMA bridge angiopathy between patients who had quit smoking and those who had never smoked after CABG(OR=0.947,95%CI:0.514-1.746).Statins were associated with a reduced risk of LIMA bridge vascular disease(OR=0.402,95%CI:0.235-0.687).Conclusions:The incidence of LIMA bridge angiopathy was 27.5%in patients with recurrent chest pain after CABG.Smoking cessation and statin use after CABG were associated with a reduced incidence of LIMA bridge angiopathy.