Effect Of Scutellarin On Patency Of Grafts After Coronary Artery Bypass Grafting

Objective: Coronary atherosclerotic heart disease is one of the public health problem that seriously endangers human health,and it is rising in morbidity and mortality every year.In patients with complicated multi-branch coronary artery disease,coronary artery bypass grafting(CABG)is often the method of choice for revascularization in order to effectively protect the surviving myocardium,but postoperative restenosis of the bridge vessels can seriously affect the long-term outcome of CABG.At present,"dual antiplatelet" scheme is mainly used to prevent bridging vascular restenosis,but previous studies have found that there are significant individual differences in the therapeutic effects of "dual antiplatelet" drugs.As the main active substancein breviscapine,scutellarin(SCU)has many pharmacological effects,such as antithrombotic,anticoagulant,anti-inflammatory,anti-oxidative stress,anti-atherosclerosis and so on.It has been used to prevent various cardiovascular and cerebrovascular diseases,but it has not been reported in the prevention of restenosis of bridging vessels.In the previous animal experiments,Our research group found that scutellarin plays a certain role in alleviating bridging vein restenosis.The purpose of this study was to observe the effect of scutellarin on the patency of saphenous vein bridge(SVG)and left internal mammary artery(LIMA)after CABG,and to provide new ideas for clinical medication after CABG.Methods: 60 patients who received the first CABG surgery from January 2021 to January 2022 in the Department of Cardiovascular Surgery,The First Affiliated Hospital of Kunming Medical University were randomly divided into two groups:scutellarin group(n=30)and control group(n=30).The scutellarin group received oral treatment of breviscapine tablets(40 mg each time,three times a day)and aspirin(100 mg/d)and clopidogrel(75 mg/d).The control group accepted oral treatment with placebo that was the same shape,color,and size as the breviscapine tablets(1 tablet each time,three times a day)and aspirin(100 mg/d)and clopidogrel(75 mg/d).Except the above-mentioned drugs,patients in both groups received standardized secondary prevention medication after CABG.General clinical data were collected,such as age,sex,body mass index,hypertension,diabetes,hyperlipidemia,smoking history,family history,previous myocardial infarction history,percutaneous coronary intervention(PCI)history and so on.64-row spiral computed tomography(CT)was used for coronary angiography at 3 and 6 months after operation postoperatively to assess the patency of SVG and LIMA.Ultrasonic cardiogram was performed before and 6 months after operation to evaluate the cardiac function,including left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).The bleeding status and major adverse cardiovascular events(MACE)of the two groups were followed up at 6 months after the operation.Results: 1.All the 60 patients were followed up,and there were no cases of shedding or death.There was no statistically significant difference between the general clinical data of the scutellarin group and the control group(P>0.05).2.There were 170 bridge vessels(LIMA 54,SVG 116)used intraoperatively in both groups,of which 83 bridge vessels(LIMA 27,SVG 56)were used in the scutellarin group and 87 bridge vessels(LIMA 27,SVG 60)were used in the control group.No statistical significance was found in the number of bridging vessels and anastomosis locations used in the scutellarin group and the control group(P > 0.05).3.The patency rate of SVG in the scutellarin group was higher than that in the control group at 3 months after operation,but no statistically significant differences were found between the two groups(P>0.05);At 6 months postoperatively,a significantly higher SVG patency rate was observed in the scutellarin group than in the control group,with statistically significant differences(P<0.05).4.At 3 and 6 months after surgery,the LIMA patency rate was higher in the scutellarin group than in the control group,while the difference were not statistically significant(P>0.05).5.There was no significant difference in LVEDD and LVEF between the scutellarin group and the control group before operation and 6 months after operation(P>0.05).But at 6 months postoperatively,a decrease in LVEDD and an increase in LVEF were observed in both groups,and the decrease in LVEDD and increase in LVEF were more pronounced in the scutellarin group than in the control group(P<0.01).6.The incidence of MACE in the scutellarin group was not statistically significant compared with the control group(P>0.05).7.The bleeding event rates were not significantly different between the scutellarin group and the control group(P>0.05).Conclusion: As a multi-pathway and multi-target drug,scutellarin combined with aspirin and clopidogrel after CABG can effectively improve the patency rate of SVG,preventing cardiac function,reducing ventricular remodeling without significantly increase the risk of bleeding,which provides a new treatment for the prevention of bridging vascular restenosis after CABG.