Comparison Of Severity Of Myocardial Injury And Prognosis Between Emergency PCI And Emergency OPCAB In The Treatment Of NSTEMI

Objective:The aim of the study was to compare the degree of myocardial injury caused by emergency percutaneous coronary intervention(PCI)and emergency off-pump coronary artery bypass grafting(OPCAB)in the treatment of non-ST-elevation myocardial infarction(NSTEMI)patients,to compare the clinical results of perioperative period and3-year follow-up,to investigate the feasibility and safety of emergency OPCAB in the treatment of NSTEMI patients.Methods:Emergency OPCAB group: 62 patients with NSTEMI who underwent emergency OPCAB procedure in the Department of Cardiovascular Surgery of Qingdao Municipal Hospital from January 2013 to January 2018 were enrolled in our study.Emergency PCI group: 62 NSTEMI patients who underwent emergency PCI treatment during the same period from the Department of Cardiovascular Medicine of our hospital were matched with OPCAB in a ratio of 1∶1.All patients were assayed the NT-pro BNP,CK-MB and hs-c Tn I before surgery,2 hours after,6 hours after,1 day after and 2 days after surgery.The left ventricular diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were recorded before surgery,1 week after surgery and 3 months after surgery.The indicators and perioperative results of the two groups were analyzed and compared.At the same time,the patients in the two groups were followed up for 3 years,and the major adverse cardiac and cerebrovascular events(MACCE),including all-cause death,recurrent myocardial infarction,cerebrovascular accident and re-revascularization,were compared between the two groups.SPSS 26.0 statistical software was used for statistical analysis of the data,and Graph Pad Prism 8.0 software was used for graphing and visualization processing of the data.Kaplan-Meier method was used to analyze the cumulative survival rate and MACCE event exemption rate,and survival curves were drawn.Log-rank test was used to test the differences between the two groups of data.P value of less than 0.05 was considered statistically significant.Results:1.There was no statistical significance in perioperative death and complications between the two groups(P > 0.05).2.The levels of CK-MB,hs-c Tn I and NT-pro BNP in both groups were increased after surgery,and the difference was statistically significant compared with that before surgery(P < 0.05).The level of emergency OPCAB group was higher than emergency PCI group at all time points,and the difference was statistically significant(P < 0.05).3.The LVEF level of the two groups increased one week after surgery,with no statistically significant difference(P > 0.05).At three months after surgery,the LVEF level of the two groups was significantly improved,with statistically significant difference(P <0.05).There was no significant difference in LVEF between the two groups one week after surgery and three months after surgery(P=0.183;P = 0.287).4.LVEDD was significantly reduced in both groups at one week and three months after surgery,which reached statistical significance(P < 0.05).Compared with the two groups,there was significant difference in LVEDD one week after surgery(P=0.000),and there was no statistical significance at three months after surgery(P=0.087).5.There was no significant difference in mortality and MACCE events between the two groups(P(log-rank)= 0.54 and 0.71,respectively)during the 3-year follow-up.The incidence of recurrent angina pectoris in emergency PCI group was higher than that in emergency OPCAB group,and the difference was statistically significant(29.0% vs 12.9%,P=0.027).Conclusions:1.The degree of myocardial damage in emergency OPCAB in NSTEMI patients was far greater than that in emergency PCI,with statistical significance(P < 0.05).However,there was no significant difference in the incidence of postoperative myocardial infarction between the two groups(P > 0.05).Emergency OPCAB is not inferior to emergency PCI in improving cardiac function and early prognosis.2.Emergency OPCAB can be performed safely and effectively with good hospitalization outcomes.As complete revascularization was achieved,the long-term results were acceptable.Therefore,the OPCAB strategy could be a good choice for patients with NSTEMI who require emergency surgery.