Harskamp Ralf E, Walker Patrick F, Alexander John H, Xian Ying, Liberman Henry A, de Winter Robbert J, Vassiliades Thomas A, Peterson Eric D, Puskas John D, Halkos Michael E
Duke Clinical Research Institute, Durham, NC; Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
Divisions of Cardiothoracic Surgery and Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, GA.
Am Heart J. 2014 Oct;168(4):471-8. doi: 10.1016/j.ahj.2014.06.027. Epub 2014 Jul 11.
Hybrid coronary revascularization (HCR) involves minimally invasive left internal mammary artery to left anterior descending coronary artery grafting combined with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. The safety and efficacy of HCR among diabetic patients are unknown.
Patients with diabetes were included who underwent HCR at a US academic center between October 2003 and September 2013. These patients were matched 1:5 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity score (PS)-matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and inhospital complications, a composite measure of 30-day mortality, myocardial infarction and stroke, and up to 3-year all-cause mortality.
Of 618 patients (HCR = 103; CABG = 515) in the PS-matched cohort, the 30-day composite of death, MI, or stroke after HCR and CABG was 4.9% and 3.9% (odds ratio: 1.25; 95% CI [0.47-3.33]; P = .66). Compared with CABG, HCR also had similar need for reoperation (7.6% versus 6.3%; P = .60) and renal failure (4.2% versus 4.9%; P = .76) but required less blood products (31.4% versus. 65.8%; P < .0001), lower chest tube drainage (655 mL [412-916] versus 898 mL [664-1240]; P < .0001), and shorter length of stay (<5 days: 48.3% versus 25.3%; P < .0001). Over a 3-year follow-up period, mortality was similar after HCR and CABG (12.3% versus 14.9%, hazard ratio: 0.94, 95% CI [0.47-1.88]; P = .86).
Among diabetic patients, the use of HCR appears to be safe and has similar longitudinal outcomes but is associated with less blood product usage and faster recovery than conventional CABG surgery.
杂交冠状动脉血运重建术（HCR）包括微创左乳内动脉至左前降支冠状动脉搭桥术联合非左前降支血管的经皮冠状动脉介入治疗（PCI）。HCR在糖尿病患者中的安全性和有效性尚不清楚。
纳入2003年10月至2013年9月在美国一家学术中心接受HCR的糖尿病患者。使用倾向评分（PS）匹配算法将这些患者与接受冠状动脉搭桥术（CABG）治疗的类似患者按1:5进行匹配。采用条件逻辑回归和基于匹配对分层的Cox回归来评估HCR与住院并发症、30天死亡率、心肌梗死和中风的综合指标以及长达3年的全因死亡率之间的关联。
在PS匹配队列中的618例患者（HCR = 103；CABG = 515）中，HCR和CABG后30天死亡、心肌梗死或中风的综合发生率分别为4.9%和3.9%（比值比：1.25；95%可信区间[0.47 - 3.33]；P = 0.66）。与CABG相比，HCR再次手术的需求也相似（7.6%对6.3%；P = 0.60），肾衰竭发生率也相似（4.2%对4.9%；P = 0.76），但需要的血制品更少（31.4%对65.8%；P < 0.0001），胸腔引流管引流量更低（655 mL[412 - 916]对898 mL[664 - 1240]；P < 0.0001），住院时间更短（<5天：48.3%对25.3%；P < 0.0001）。在3年的随访期内，HCR和CABG后的死亡率相似（12.3%对14.9%，风险比：0.94，95%可信区间[0.47 - 1.88]；P = 0.86）。
在糖尿病患者中，使用HCR似乎是安全的，且具有相似的长期预后，但与传统CABG手术相比，血制品使用更少，恢复更快。
