摘要
目的探讨接受左乳内动脉-左前降支(LIMA-LAD)冠状动脉旁路移植术(CABG)的患者术后发生桥血管狭窄的影响因素。方法回顾性分析2019年7月—2020年12月海南医学院第二附属医院收治的在CABG术后因复发胸闷、胸痛等症状接受冠脉造影的86例患者的临床资料,根据LIMA-LAD桥血管狭窄程度将患者分为狭窄组(n=25)与非狭窄组(n=61),狭窄组患者的桥血管狭窄≥50%,非狭窄组患者的桥血管狭窄<50%。比较两组患者的一般资料、既往病史、CABG术中资料、此次就诊资料与生化指标。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^(2)检验。采用Logistic回归分析筛选出CABG术后导致桥血管狭窄的影响因素,采用R 4.0.2软件中的rms程序包建立列线图预测模型,采用受试者操作特征(ROC)曲线评价模型的区分度,使用校正曲线和偏差校正C-index对列线图预测模型作出评价。采用X-tile软件获得列线图模型积分的截断值,采用Kaplan-Meier法绘制生存曲线,并用Log-rank法进行检验。结果Logistic回归分析结果显示,吸烟、高血压、CABG术前左前降支(LAD)狭窄<75%、CABG术前左乳内动脉(LIMA)血流、冠脉造影弥漫性病变是影响CABG术后LIMA-LAD桥血管狭窄的独立危险因素(P<0.05)。列线图模型预测的C-index值为0.879(95%CI:0.818~0.955,P<0.001),ROC曲线下面积为0.712(95%CI:0.594~0.801,P<0.001),区分度较好;校准曲线显示,模型预测的准确度较好。通过X-tile软件筛选获取模型积分截断值,将患者分为低风险组(≤54分)、中风险组(>54分且≤112分)、高风险组(>112分),生存分析结果显示,3组患者术后桥血管狭窄的发生率分别为20.9%、50.0%和80.0%。结论吸烟、高血压、CABG术前LAD狭窄<75%、CABG术前LIMA血流、冠脉造影弥漫性病变是影响CABG术后LIMA-LAD桥血管狭窄的独立危险因素,构建列线图预测模型可以为CABG术前评估靶�
Objective To explore the influencing factors of postoperative graft stenosis in patients undergoing left internal mammary artery-left anterior descending branch(LIMA-LAD)coronary artery bypass graft(CABG)surgery.Methods A retrospective analysis of the clinical data of 86 patients who were admitted to the Second Affiliated Hospital of Hainan Medical College and received coronary angiography after CABG surgery from July 2019 to December 2020 due to recurrent chest tightness,chest pain and other symptoms.According to the degree of stenosis of the LIMA-LAD graft,the patients were divided into stenosis group(n=25)and non-stenosis group(n=61).The graft stenosis of patients in the stenosis group was≥50%,and the graft stenosis of patients in the non-stenotic group was less than 50%.The general information,past medical history,CABG intraoperative data,current visit data and biochemical indicators of the two groups were compared.Measurement data were expressed as mean±standard deviation(Mean±SD),comparison between groups was by t-test;count data comparison between groups was by Chi-square test.Logistic regression analysis was used to screen out the influencing factors of graft stenosis after CABG.Use the rms package in the R 4.0.2 software to build a nomogram prediction model.Using receiver operating characteristic(ROC)curve to evaluate the discriminative degree of the model.Use the calibration curve and deviation correction C-index to evaluate the nomogram prediction model.Use X-tile software to obtain the cutoff value of the nomogram model integral,use Kaplan-Meier method to draw the survival curve,and use Log-rank to test.Results Logistic regression analysis showed that smoking,hypertension,pre-CABG left anterior descending branch(LAD)stenosis<75%,pre-CABG left internal mammary artery(LIMA)blood flow,and coronary angiography diffuse lesions are independent risk factors that affect LIMA-LAD graft stenosis after CABG(P<0.05).The C-index value predicted by the nomogram model was 0.879(95%CI:0.818-0.955,P<0.001).The are
作者
陈泽伦
王天光
赵朝阳
王石坚
Chen Zelun;Wang Tianguang;Zhao Chaoyang;Wang Shijian(Department of Cardiovascular Surgery,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China)
出处
《国际外科学杂志》
2021年第12期802-808,F0003,共8页
International Journal of Surgery
基金
海南省基础与应用基础研究计划(2019RC382)。
关键词
冠状动脉旁路移植术
非体外循环
冠状动脉疾病
左乳内动脉
左前降支
列线图
Coronary artery bypass,off-pump
Coronary artery disease
Left internal mammary artery
Left anterior descending branch
Nomograms
