Duke Clinical Research Institute, Durham, NC; Academic Medical Center, University of Amsterdam, The Netherlands.
Divisions of Cardiothoracic Surgery and Cardiology, Clinical Research Unit, Emory University School of Medicine, Atlanta, GA.
J Am Coll Surg. 2015 Aug;221(2):326-34.e1. doi: 10.1016/j.jamcollsurg.2015.03.012. Epub 2015 Mar 20.
Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery to left anterior descending bypass with percutaneous coronary intervention of non-left anterior descending vessels. Its safety and effectiveness compared with conventional CABG have been under studied.
Patients with multivessel disease and/or left main disease who underwent HCR at a US academic center between October 2003 and September 2013 were included. These patients were matched 1:3 to patients treated with CABG using a propensity-score matching algorithm. Conditional logistic regression and Cox regression analyses stratified on matched pairs were performed to evaluate the adjusted association between HCR and short- and long-term outcomes.
The 30-day composite of death, MI, or stroke after HCR and CABG was 3.3% and 3.1% (odds ratio = 1.07; 95% CI, 0.52-2.21; p = 0.85) in the matched cohort of 1,224 patients (HCR, n =306; CABG, n = 918). Hybrid coronary revascularization was associated with lower rates of in-hospital major morbidity (8.5% vs 15.5%; p = 0.005), lower blood transfusion use (21.6% vs 46.6%; p < 0.001), lower chest tube drainage (690 mL; 25th to 75th percentile: 485 to 1,050 mL vs 920 mL, 25th to 75th percentile: 710 to 1,230 mL; p < 0.001), and shorter postoperative length of stay (<5-day stay: 52.6% vs 38.1%; p = 0.001). During a 3-year follow-up period, mortality was similar after HCR and CABG (8.8% vs 10.2%; hazard ratio = 0.91; 95% CI, 0.55-1.52; p = 0.72). Subgroup analyses in patients stratified by 2-vessel, 3-vessel, left main disease, and by Society of Thoracic Surgeons risk scores rendered similar results.
The use of HCR appeared to be safe, with faster recovery and similar outcomes when compared with conventional CABG. These findings were consistent irrespective of anatomic or predicted procedural risk.
杂交冠状动脉血运重建（HCR）将微创左内乳动脉与非前降支的经皮冠状动脉介入治疗相结合。与传统的冠状动脉旁路移植术（CABG）相比，其安全性和有效性尚未得到充分研究。
本研究纳入了 2003 年 10 月至 2013 年 9 月期间在美国学术中心接受 HCR 治疗的多支血管疾病和/或左主干疾病患者。这些患者采用倾向评分匹配算法按 1:3 与接受 CABG 治疗的患者进行匹配。采用条件逻辑回归和 Cox 回归分析，按匹配对分层，评估 HCR 与短期和长期结果之间的调整关联。
在 1224 例患者（HCR 组 n=306；CABG 组 n=918）的匹配队列中，HCR 和 CABG 术后 30 天的死亡、心肌梗死或卒中等复合终点发生率分别为 3.3%和 3.1%（比值比=1.07；95%置信区间，0.52-2.21；p=0.85）。与 CABG 相比，HCR 与较低的院内主要并发症发生率（8.5%比 15.5%；p=0.005）、较低的输血使用率（21.6%比 46.6%；p<0.001）、较低的胸腔引流量（690ml；25%至 75%分位数：485 至 1050ml 比 920ml；25%至 75%分位数：710 至 1230ml；p<0.001）和较短的术后住院时间（<5 天：52.6%比 38.1%；p=0.001）相关。在 3 年的随访期间，HCR 和 CABG 的死亡率相似（8.8%比 10.2%；风险比=0.91；95%置信区间，0.55-1.52；p=0.72）。根据 2 支血管、3 支血管、左主干疾病和胸外科医师协会风险评分对患者进行亚组分析，结果相似。
与传统的 CABG 相比，HCR 似乎是安全的，恢复更快，结果相似。这些发现与解剖或预测的手术风险无关。
