Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
JACC Cardiovasc Interv. 2014 Nov;7(11):1277-83. doi: 10.1016/j.jcin.2014.05.025. Epub 2014 Nov 17.
The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).
Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known.
A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed.
Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed.
HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567).
本研究旨在评估多支冠状动脉疾病（MVCAD）患者行标准冠状动脉旁路移植术（CABG）时行杂交冠状动脉血运重建术（HCR）的可行性。
传统 CABG 仍然是 MVCAD 患者的首选治疗方法。然而，标准 CABG 的局限性以及隐静脉移植物长期通畅率不理想是众所周知的。
共 200 例 MVCAD 患者（LAD 受累且至少 1 条主要心外膜血管（除 LAD 外）存在临界病变（>70%），适合 PCI 和 CABG）被随机分配行 HCR 或 CABG（1:1 比例）。主要终点是评估 HCR 的安全性。可行性通过完全 HCR 手术的患者比例和转为标准 CABG 的患者比例来定义。还评估了随机分组后 12 个月内主要不良心脏事件（死亡、心肌梗死、卒中和再次血运重建）的发生率。
两组患者的大多数术前特征相似。在杂交组中，93.9%的患者完成了完全 HCR，6.1%的患者转为标准 CABG。12 个月时，两组死亡率（2.0%比 2.9%，p=NS）、心肌梗死（6.1%比 3.9%，p=NS）、大出血（2%比 2%，p=NS）和再次血运重建（2%比 0%，p=NS）发生率相似。两组均未发生脑血管事件。
在因标准 CABG 而转诊的 MVCAD 患者中，HCR 是可行的。（多支冠状动脉疾病杂交血运重建的安全性和有效性研究 [POL-MIDES]；NCT01035567）。
