Analyze of long-term prognosis of coronary artery bypass grafting in patients with coronary atherosclerotic and chronic kidney disease
Li Yang, Dong Ran, Rui Hongliang, Liu Taoshuai, Zheng Jubing, Xu Xiaoyu, Zhao Yang, Song Bangrong, Zhang Kui
2020, 41(4):
597-602.
doi:10.3969/j.issn.1006-7795.2020.04.016
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Objective To analyze the prognosis and factors of coronary artery bypass grafting (CABG) in patients with chronic kidney disease(CKD). Methods The clinical data of 1056 patients with chronic kidney disease who underwent CABG in Anzhen Hospital, Capital Medical University from January 2007 to December 2018 were collected,and the long-term follow-up were completed, which included basic perioperative information, surgical procedure, operative complication, and hospitalization costs. Results The level of preoperative creatinine was (184.56±145.93) mmol/L, estimated glomerular filtration rate(eGFR)was (34.57±12.61) mL·min-1·1.73 m-2,and the cases of phase 3 to 5 of CKD were 739, 226, and 91 patients, respectively. A total of 183 patients (17.3%) were diagnosed with left main stenosis. The average number of lesion vessels was 3.02±0.73, the proportion of off-pump CABG was 936 (88.6%), and the average graft number were 2.92±0.82. The mortality rate was 6.1% (64 case), and the incidence rate of acute kidney failure, reoperation for stanching, and perioperative myocardial infarction was 83(7.9%), 73(6.9%), and 134(12.7%), and 155(14.7%) respectively. The follow-up rate was 92.2% and the median follow-up time was 6 years (1-11 years). The long-term survival rate was 93.6%,74.7% patients occurred without major adverse cardiac and cerebrovascular events (MACCE), and 58 died from all-cause. Logistics regression analyze showed that the female, emergency surgery, dialysis, cerebral infarction history, and left main stenosis were positively correlated with perioperative death (P=0.039,0.037,0.020,0.009,0.000), whereas off-pump coronary bypass grafting (OPCABG) was negatively correlated with perioperative death (P=0.002). The dialysis history, higher level of triglyceride, and chronic obstructive pulmonary diseases (COPD) were independent risk factors of MACCE (P=0.016,0.003,0.031). Conclusion The risk of CABG procedure in patients with CKD was obviously high. The female, emergency surgery, dialysis, cerebral infarction history, and left main stenosis were independent risk factors of death, whilst OPCABG was protective factor. The dialysis history, higher level of triglyceride, and COPD were independent risk factors of MACCE.
