Coronary artery disease (CAD) is a cardiovascular disease mainly caused by atherosclerosis, which involves a variety of pathophysiological mechanisms such as lipid metabolism, inflammatory response, and endothelial dysfunction. Fetuin B is a glycoprotein secreted by the liver, which can participate in many processes such as cell inflammation, vascular calcification, and lipid metabolism, and is closely related to the pathogenesis of CAD. This article reviews the relationship between fetuin B and CAD and the mechanism of its occurrence and development, in order to provide new choices and methods for the prevention, diagnosis, and treatment of CAD.
ObjectiveTo investigate the early clinical efficacy of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) via left intercostal small incision for multivessel coronary artery disease. MethodsThe patients who received off-pump CABG in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group and a left intercostal small incision group. The clinical data of the two groups were compared. ResultsA total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left intercostal small incision group. The age of the patients in the left intercostal small incision group and the traditional midline sternotomy group was (63.8±8.0) years and (63.0±7.8) years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left intercostal small incision group were converted to thoracotomy. The patients in the left intercostal small incision group showed less postoperative drainage within postoperative 24 hours [(239.4±177.7) mL vs. (338.0±151.9) mL, P<0.001], lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay [(10.8±4.0) d vs. (13.1±5.3) d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. ConclusionCompared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.
ObjectiveTo systematically review the long-term efficacy of coronary artery bypass grafting (CABG) versus drug-eluting stent implantation (DES-PCI) for patients with multivessel coronary artery disease.
MethodsWe searched The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP to collect randomized controlled trials (RCTs) about CABG versus DES-PCI for patients with coronary multivessel disease from the inception to October 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.2 software.
ResultsA total of seven RCTs, involving 5 723 patients were included. The results of meta-analysis showed that: compared with the DES-PCI group, the CABG group had lower 1-year incidence of target vessel revascularization (OR=0.39, 95%CI 0.31 to 0.48, P<0.000 01), 5-year mortality (OR=0.78, 95%CI 0.65 to 0.94, P=0.008), and 5-year incidence of myocardial infarction (OR=0.46, 95%CI 0.37 to 0.58, P<0.000 01). However, 1-year, 2-year and 5-year incidences of stroke in the CABG group were significantly higher than that in the DES-PCI group (all P values <0.05).
ConclusionThe available evidence suggests that CABG is superior to DES-PCI for patients with multivessel coronary artery disease in long-term effects, but CABG could increase the incidence of stroke. Due to the quantity and quality of the included studies, the above conclusions still need to be verified by more high-quality RCTs.
Gut microbiota and its metabolites in various human diseases have gradually become a research hotspot in the current medical community. And coronary artery disease is currently one of the most threatening clinical cardiovascular diseases in the world, so the use of gut microbiota and its metabolites in the development of its pathophysiology has also received more and more attention. Therefore, this paper reviews the effects of gut microbiota and its metabolites on coronary artery disease, as well as the research progress of intervening gut microbiota and its metabolites as therapeutic targets, hoping to expand the future research direction in this field and provide new ideas with treating coronary artery disease.
Objective To evaluate the outcome and explore the mechanism of coronary vein bypass grafting （CVBG） performed by anastomosing the right internal mammary artery with the middle cardiac vein via off-pump surgery. Methods Twelve Chinese experimental miniswines （either male or female, age from 7 to 10 months, body weight 40±5 kg） with severely diffuse stenosis in the right coronary artery were randomly divided into control group and experiment group with 6 miniswines in each group, using a random number table method. CVBG was performed in the experiment group and sham surgery was performed in the control group. To assess cardiac function, graft flow, graft patency and micro-circulation reperfusion of ischemia myocardium, following measurements were conducted. Eight weeks after right coronary endarterectomy, transthoracic echocardiography was performed for both groups. Coronary angiography, graft flow and echocardiography were performed or measured 6 hours and 3 months after CVBG or sham surgery. Measurement of myocardial blood flow with non-radioactive colored microspheres was also conducted 3 months after surgery for two groups. Results There was no statistical difference in cardiac function 8 weeks after right coronary endarterectomy between the two groups. There were significant improvements in cardiac systolic and diastolic function （ejection fraction 3 months after operation: 52%±6% vs. 44%±5%, t=-2.500, P=0.031） in the experiment group after CVBG compared with the control group. Graft flow of the experiment group 6 hours and 3 months after CVBG were 44.50±5.86 ml/min and 43.33±5.01ml/min respectively （P=0.718）, and pulsatility index （PI） was 0.73±0.14 and 0.80±0.14 respectively（P=0.858）. Internal mammary artery grafts and the anastomoses were all patent without stenosis, documented by coronary artery angiography for the experiment group 6 hours and 3 months after CVBG. Myocardial flow in all aspects especially in the subendocardial layer, estimated by non-radioactive colored microsphere injection, was significantly higher in the experiment group after CVBG than that of the control group, transmural flow was 0.33±0.05ml/（g ? min） vs. 0.19±0.03 ml/（g ? min） （P＜0.05）. Conclusion Ischemic conditions of the myocardium can be relieved by CVBG using internal mammary artery in a short-term to medium-term period. The mechanism may be due to improvement of the myocardial micro-circulation.
ObjectiveTo analyze the safety and follow-up results of on-pump coronary artery bypass grafting (CABG) for the treatment of multivessel diseases via left anterolateral minithoracotomy.MethodsFrom January 2018 to March 2020, a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy. Among them, 14 patients had three-vessel diseases and 16 patients had two-vessel diseases.ResultsThere were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts. The average number of bypass vessels was 2.3±0.5. There was no perioperative death in the whole group, one patient underwent rethoracotomy due to hemorrhage, and one patient suffered acute renal insufficiency. The average time of postoperative tracheal intubation was 16.0±5.8 hours, and the postoperative ICU stay was 30.1±11.5 hours. Twenty five patients were followed up, including coronary CT angiography examinations at 6 months and 1 year after operation. Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred.ConclusionOn-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.
ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
Objective To systematically review the efficacy, safety and economic value of hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) for Chinese patients with multivessel coronary artery disease. Methods We searched PubMed, WanFang Data, CNKI, Web of Science and The Cochrane Library (Issue 2, 2016) to collect case-control studies about HCR versus CABG for Chinese patients with coronary multivessel disease from the January 1996 to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies, involving 1 231 patients were included. The results of meta-analysis showed that: compared with the CABG groups, HCR group had lower length of ICU stay (MD=–25.84, 95% CI –42.55 to –9.13,P=0.002) and intubation time (MD=–4.06, 95% CI –6.43 to –1.69,P=0.000 8). However, there were no significant differences between both groups in the length of hospital stay (MD=–0.64, 95% CI –2.53 to 1.25,P=0.51), the incidence of atrial fibrillation (OR=1.41, 95% CI 0.86 to 2.30,P=0.17) and renal failure (OR=1.56, 95% CI 0.89 to 2.74,P=0.12). No significant differences were found between both groups in mortality (OR=0.36, 95% CI 0.12 to 1.11,P=0.07), the incidence of myocardial infarction (OR=0.32, 95% CI 0.06 to 1.85,P=0.20) and the incidence of target vessel revascularization (OR=1.16, 95% CI 0.48 to 2.76,P=0.74). But the incidence of the stroke (OR=0.35, 95% CI 0.14 to 0.91,P=0.03) and MACCEs (OR=0.37, 95% CI 0.20 to 0.70,P=0.002) of the HCR group were lower than those of the patients of the CABG group. Conclusion The current evidence shows that, compared with the CABG groups, HCR had lower incidence of stroke and MACCEs, however, the safety and efficacy were not significantly different between both groups. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To introduce the technique of surgical patch angioplasty for the treatment of patients with isolated left main coronary artery stenosis. Methods Retrospective investigation of results of surgical patch angioplasty in patients with isolated left main coronary artery disease. Results All 8 patients who underwent left main coronary artery patch angioplasty survived with no major perioperative complications. One patient had recurrent angina and required coronary artery bypass grafting 6 months after patch angioplasty. All other patients were symptom free and had normal activity, at a mean follow-up of 5. 3 years. Conclusions Patch angioplasty can be used as an alternative surgical technique in cases of isolated left main coronary artery stenosis with no distal coronary artery disease. However, it may not be suitable for patients with significant left main coronary artery calcification.
摘要:目的:了解血肌酐清除率受損是否與冠心病患病率存在聯系。方法:納入2006年7月至2008年2月期間經冠狀動脈造影證實的冠心病患者及年齡、性別匹配的對照組,按血肌酐清除率值將患者分為正常［≥90 mg/（mL·173 m2)］,輕度受損［≥60 mg/（mL·1.73 m2）,lt;90 mg/（mL·1.73 m2)］和明顯受損［lt;60 mg/（mL·1.73 m2)］。比較冠心病組與對照組各組人群的比例有無差異。結果:研究期間共納入冠心病組和對照組患者各116例。在冠心病組中,血肌酐清除率正常患者82例、輕度受損29例、重度受損5例,對照組中,正常患者98例、輕度受損13例、重度受損5例,〖JP3〗兩組比較分布有統計學差異(χ2值7.517,P=0.023)。與對照組比較,冠心病組的血清肌酐值無明顯差異（Pgt;005)，〖JP〗冠心病組（103.29±51.08） μmol/L,對照組（102.67±41.21）μmol/L。結論:血肌酐清除率降低是冠心病的危險因素。Abstract: Objective: To disclose the relation of the estimated glomerular filtration rate (eGFR) and coronary artery disease. Methods：We analyzed eGFR in the patients with coronary artery disease confirmed by coronary angiography and the control, and compared the proportion of patients with reduced renal function in the different groups. Results: A total 116 cases were included in each group. Among these patients, normal renal function, mildly and severe reduced renal function was documented in 82, 29 and 5 in coronary artery disease group, and in 98, 13 and 5 in the control group, respectively. In comparison to the control, more patients with reduced eGFR were found in coronary artery disease group (χ2 value 7.517,P=0.023), although no significant difference was observed between both groups（Pgt;0.05). Conclusion: Reduced eGFR, even if mildly, could be regarded as the risk factor of coronary artery disease.
