Prognosis of Patients with Diffuse Coronary Artery Disease Treated by Off-pump Coronary Artery Bypass Grafting Combined with Endarterectomy

GAO Jianchao; YANG Kan; HAN Dong; LI Lili

doi:10.12102/j.issn.1672-1349.2025.24.020

Abstract：Objective: To analyze the prognosis of off-pump coronary artery bypass grafting combined with endarterectomy in the treatment of diffuse coronary artery disease. Methods: A total of 416 patients with diffuse coronary artery disease who underwent surgery between January 2011 and December 2017 were selected and divided into a control group (coronary artery bypass grafting, 183 cases) and an observation group (coronary artery bypass grafting combined with coronary artery endarterectomy, 233 cases) based on the surgical method. The surgical parameters, postoperative 30-day and long-term prognosis, and 5-year survival rates were compared between the two groups. The influencing factors of major adverse cardiac and cerebral events in patients with diffuse coronary artery disease were analyzed. Results: There were no statistically significant differences between the two groups in terms of intensive care unit (ICU) treatment time, ventilator assistance time, pleural effusion volume, postoperative blood transfusion, incidence of cerebral infarction within 30 days after surgery, reoperation rate for hemostasis, continuous renal replacement therapy rate, and overall mortality (P > 0.05). The incidence of myocardial infarction within 30 days after surgery was higher in the observation group than in the control group (P < 0.05). The follow-up period was 54.00 (48.00, 60.00) months. There were no statistically significant differences between the two groups in terms of overall mortality, cardiac mortality, non-cardiac mortality, non-fatal myocardial infarction, stroke, repeat coronary artery revascularization, and the incidence of major adverse cardiac and cerebral events during the follow-up period (P > 0.05). The average survival time of the control group at 5 years post-surgery was (58.14 ± 0.65) months, while that of the observation group was (57.23 ± 0.71) months. There was no statistically significant difference in the 5-year survival rate between the two groups (Log-rank x2 = 0.458, P > 0.05). Univariate and multivariate analysis results showed that age and peripheral vascular disease were independent risk factors for major adverse cardiac and cerebral events after surgery in patients with diffuse coronary artery disease (P < 0.05). Conclusion: In the surgical treatment of patients with diffuse coronary artery disease, coronary artery bypass grafting combined with coronary artery endarterectomy increases the risk of myocardial infarction in the short term after surgery, but there is no significant difference in long-term survival compared to patients who received only coronary artery bypass grafting.