Comparison Of The Surgical Effect For Patients Undergoing Off-pump Coronary Artery Bypass Grafting At Different Early Stages After Acute Myocardial Infarction

Objectives:To compare the surgical effect of patients undergoing off-pump coronary artery bypass at different early stages after acute myocardial infarction,the operation time was about at the second week,the third week and the forth week after they were attacked by acute myocardial infarction,all the patients were with normal myocardial enzymes and approximately normal cardiac function.Methods:Bring 59 patients visiting the Affiliated Hospital of Hebei University,the Beijing Anzhen Hospital Affiliated to Capital Medicinal University and the Beijing ChaoYang Hospital Affiliated to Capital Medicinal University in January 2016 to June 2017,with acute myocardial infarction and with the plan to undergo the off-pump-coronary artery bypass into the study.All the patients were with normal myocardial enzymes and approximately normal cardiac function.According to the time interval from the occurrence of acute myocardial infarction to the day of surgery,all enrolled patients were divided into three groups: 17 patients in group A(8-14 days),22 patients in group B(15-21 days),and 22 patients in group C(22-28).Day)20 patients,there was no statistical difference in the clinical data of the three groups before surgery.Including myocardial injury markers troponin I(Cardiac Troponin I,cTnI),heart-type fatty acid binding protein(Hearth Fatty Acid-Binding Protein,H-FABP),ischemia modified albumin level(Ischemia Modified Albumin,IMA)of clinical data collection of patients after hospital discharge summary before(perioperative mortality,etc.)and the patient was discharged after cardiac ultrasound to measure the measured LVEF compared AMI patients with AMI in the first 2 weeks,3 weeks,4 weeks after operation OPCAB.The determination of myocardial injury markers needs to be performed before surgical incision(T0),1 h(T1),3 h(T3),6 h(T6),12 h(T12),24 h(T24)collect blood from the patient and measure the levels of cTn I,H-FABP,and IMA in the blood at the above time points.Results:(1)It was found that there was a positive correlation between H-FABP and cTn I after OPCAB(r=0.281,P = 0.031).(2)The levels of cTn I,H-FABP and IMA in the three groups at the same time points A,B,and C were not statistically different(P>0.05).(3)The clinical data of LVEF,perioperative mortality,etc.were compared in groups A,B,and C.The difference was not statistically significant(P>0.05).Conclusions:(1)H-FABP was positively correlated with cTnI after OPCAB.H-FABP appeared earlier than cTn I in time,which reflected the value of H-FABP in the diagnosis of perioperative myocardial injury of OPCAB;(2)Enzymological examination showed that there were no statistical differences in the enzymological examination of OPCAB in the 2nd,3rd,and 4th week after AMI.The results showed that OPCAB did not cause significant myocardium after AMI.damage;(3)By comparing the postoperative clinical data,the three groups of OPCAB patients at the second,third,and fourth weeks of AMI were found to have no statistically significant difference in clinical data.The results showed that the difference in surgical timing did not result in differences in postoperative outcomes.(4)The above results show that for patients with angina pectoris who require OPCAB in the early stage of AMI,such as 2 weeks or 3 weeks,except for surgical contraindications,early surgery can be considered as much as possible to avoid cardiovascular malignancy.Some patients do not necessarily follow the traditional concept until the AMI occurs 4-6 weeks later.Therefore,under the premise of reasonable indications and case selection,OPCAB was chosen at 2 weeks and 3 weeks after AMI.Compared with OPCAB at 4 weeks after AMI,the surgical results were also safe and accurate.