The Value Of Incomplete Revascularization In Patients With Multivessel Coronary Artery Disease And Chronic Kidney Disease

Objective To compare the clinical prognosis and intraoperative complications of incomplete revascularization and complete revascularization in patients with multi-vessel coronary artery disease complicated with chronic kidney disease.Method A total of 345 patients with multi-vessel coronary artery disease complicated with chronic kidney disease admitted to the Department of Cardiovascular Medicine of Nanxishan Hospital of Guangxi Zhuang Autonomous Region from January 2017 to January 2022 were retrospectively analyzed,According to the treatment method,they were divided into incomplete revascularization group(174 cases)and complete revascularization group(171cases).Collect general clinical data such as age,gender,blood pressure,blood glucose,blood lipid,renal function,and degree of coronary artery disease.Collect intraoperative complications by reviewing complete patient cases,including postoperative records and intraoperative images,Through telephone contact and consulting the patient’s inpatient and outpatient follow-up data,follow up MACE(all-cause death,cerebrovascular accident,recurrent angina,non-fatal myocardial infarction,heart failure,severe arrhythmia)for 1 year in the two groups.Result All patients underwent diagnostic coronary angiography,According to renal function and intraoperative coronary artery lesions,for patients with multi-vessel lesions shown by coronary angiography and patients with stage 2 chronic kidney disease or above,define the cutoff value as e GFR > 36.25 m L/min/1.73 m2 and Syntax score 33,further divide The two data groups into four groups,Group A: highly compartmental coronary artery disease+ severe renal insufficiency;Group B: low-intermediate coronary artery disease+ severe renal insufficiency;Group C: highly compartmental coronary artery disease + mild to moderate renal insufficiency;Group D was coronary artery disease and mild to moderate renal insufficiency,follow up MACE in the two groups of patients with different degrees of coronary artery disease and renal function and collecte Clinical data during the operation.A total of 333 patients were successfully followed up,The follow-up rate was 96.1%,there were 166 patients in incomplete revascularization group and 167 patients in the complete revascularization group,all patients were followed up for 1 year.In groups A,B and C,the difference in MACE in one year was statistically significant between the incomplete revascularization group and the complete revascularization group(P > 0.05).In group D,the incidence of MACE in one year was higher in the incomplete revascularization group than in the complete revascularization group(P < 0.05),which was mainly manifested in recurrent angina pectoris.Among the four groups A,B,C and D,the incidence of intraoperative complications in the incomplete revascularization group was lower than that in the complete revascularization group,and the difference was statistically significant(P < 0.05),mainly manifested in the aspect of stent incomplete dilatation.Conclusion 1.In the group of high zonal coronary artery disease combined with severe renal insufficiency,high zonal coronary artery disease combined with mild to moderate renal insufficiency,and middle to low zonal coronary artery disease combined with severe renal insufficiency,there was no difference in MACE between the incomplete revascularization group and the complete revascularization group.2.In the group of middle and low zone coronary artery lesions complicated with mild and moderate renal insufficiency,there was a difference in MACE between the incomplete revascularization group and the complete revascularization group,which was mainly reflected in the high incidence of recurrent angina pectoris.3.In patients with coronary artery disease and chronic kidney disease,compared with complete revascularization,incomplete revascularization has a lower incidence of intraoperative complications,mainly reflected in the low incidence of stent incomplete expansion.