| Objective: Coronary heart disease referred to as “coronary heart disease”, it is the most common heart disease which is serious harm to human health. Coronary heart disease(CHD) has become one of the main reasons of death and serious disability. Coronary artery bypass grafting(CABG) has been developed rapidly in recent years. It has become the primary means of treatment of coronary heart disease. However, acute thrombosis or restenosis may occur in or after surgery, at the same time, this cannot prevent the new restenosis in other parts and the appearance of major adverse cardiac and cerebrovascular events are difficult problems in clinical practice. Standard drug use is still the basis therapy for patients with coronary artery bypass graft surgery, can further improve short and long term effect of CABG. The recent study of statins shows that it not only has a role in regulating cholesterol, but also has anti-inflammatory, improve vascular endothelium, anti-atherosclerosis, improve myocardial ischemia, anti-anginal and other effects. Long-term use of these drugs can reduce the risk of major adverse cardiac and cerebrovascular events such as myocardial infarction, stroke, and death occurred and so on in high-risk patients. But follow-up studies about patients after coronary artery bypass grafting arising major adverse cardiac and cerebrovascular events and statins intervention are relatively few and these studies have different results, this study investigated the effect of major adverse cardiac and cerebrovascular events in patients after coronary artery bypass grafting by comparing the patients taking the statins or not, thereby providing new ideas and directions for the clinical aspects of coronary artery bypass grafting in patients with statins durgs, guiding clinical standard drug therapy.Methods: This study selected and retrospective analyzed 221 patients with non emergency off-pump coronary artery bypass grafting between January to December of 2013, 172 cases were followed up successfully, the follow-up rate was 77.8%. Excluding the patients with coronary artery bypass grafting associated with other surgery, or patients with serious liver and kidney dysfunction, or patients who were allergic to statins, if the patients had myalgia, arthralgia or rhabdomyolysis, or the creatine kinase of patients increased more than 5 times the upper limit of normal, if alanine aminotranserase or aspartate aminotranserase of the patients increased more than 3 times the upper limit of normal, or creatinine of patients over 221 umol/L, the patients should report and stop taking statins. Checking out medical case detailedly and recording information of medical case,clinical features, laboratory tests, coronary artery disease, revascularization, medical treatment and other basic baseline information, and following up in the way of telephone and hospital clinic, patients were asked whether appearing major adverse cardiac and cerebrovascular events, it mainly refers to againmyocardial infarction, recurrent angina, revascularization, stroke, and all-cause readmission treatment death, and we reviewed the postoperative echocardiography, the results of electrocardiogram and drugs. Patients in our department randomly were assigned to four treatment groups, this study successful followed up 172 patients, before the operation only 12 cases lipids in the normal range without taking statins, the rest patients with preoperative were statins therapy. So patients were divided into statins group(n=127) and non-statins group(n=45) according to taking statins or not. Establish a data table according to the purpose of this study, count relevant indicators, collate and summarize data in accordance with the principles and methods of statistical experimental design, process and analyze the data and build statistical tables and charts using SPSS19.0, the difference is considered being statistically significant when P<0.05, find out and summarize the relationship between the data. To analyze and discuss the statistical results of all kinds of related data, and provide guidance for clinical medication.Results: 1 The difference of sex, age, body mass index(BMI), body weight, history of hypertension, history of diabetes, history of hyperlipidemia, previous history of myocardial infarction, previous history of infarction, previous history of unstable angina, previous history of PCI, previous history of heart failure, past smoking history, preoperative ejection fraction, preoperative creatinine, bypass count, three-vessel disease, oral medication discharged, history of preoperative statins treatment baseline information between statins group and non-statins group have no statistically significant difference(P> 0.05), so the data can be compared; 2 Through the data analysis: the preoperative left ventricular ejection fraction(LVEF) of statins group is 57.8 ± 6.5%,the preoperative LVEF of non-statins group is 57.8±8.0%, P=0.965, there is no statistically significant difference of the data, so the data of two groups can be compared. The postoperative LVEF of statins group is 64.7±3.6%, the postoperative LVEF of non-statins group is 62.0±3.1%, P=0.000, there is statistically significant difference of the two groups data. It can be seen that the postoperative LVEF is higher than the preoperative LVEF, and the postoperative LVEF of statins group is higher than the non-statins group obviously; 3 When the patients are older than or equal to 65 years, the outcome of major adverse cardiac and cerebrovascular events is 2.092 times than the outcome of patients who are less than 65 years, P=0.101, although the difference when the P>0.05 has no statistical significance, but it shows that the trend of incidence for adverse cardiac and cerebrovascular events is increasing with the age increased; 4 Left main disease is an important risk factor for adverse cardiac and cerebrovascular events, the risk happening adverse cardiac and cerebrovascular events of patients with left main disease is 9.948 times than the patients with non-left main disease(P=0.001); 5 Statins treatment after surgery is a protective factor for adverse cardiac and cerebrovascular events, it can reduce the risk of major adverse cardiac and cerebrovascular events to 0.1 times of the non-statin treatment(P=0.000); 6 Survival curves were plotted using Kaplan-Meier method, data was checked using Log-rank testing method, P=0.000, and this study shows that the difference of survival rate between the two groups has statistical significance, survival time of statins group is longer than the non-statins group; 7 The incidence of again myocardial infarction, recurrent angina, stroke, rehospitalization, all-cause mortality and total MACCE events with non-statins group is higher than the statins group. However, only recurrent angina(P=0.019), all-cause mortality(P=0.002) and total MACCE events(P=0.007) have statistical significance.Conclusion:1 Statin drugs can make the left ventricular ejection fraction increased, enhance myocardial contractility and improve left ventricular function of the patients after coronary artery bypass grafting.2 Left main disease is an important risk factor for adverse cardiac and cerebrovascular events, it influences the prognostic of the coronary artery bypass grafting patients.3 Statins can reduce the mortality of coronary artery bypass graft surgery patients during the follow-up, also can reduce incidence of recurrent angina and adverse cardiac and cerebrovascular events and prolong the survival time. Statins is the protective factor which can avoid adverse cardiac and cerebrovascular events happened and improve the prognosis of patients with coronary artery bypass grafting. |
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