Song Zhizhao, Shen Liuzhong, Zheng Zhe, Xu Bo, Xiong Hui, Li Lihuan, Hu Shengshou
Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Cardiovasc Surg. 2016 Jun;151(6):1695-1701.e1. doi: 10.1016/j.jtcvs.2016.01.049. Epub 2016 Feb 13.
To compare in-hospital and midterm outcomes after one-stop hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) in patients with diabetes mellitus (DM).
The series included 120 patients with DM who underwent one-stop HCR at Fuwai Hospital between June 2007 and September 2014. These patients were 1:2 matched with 240 patients who underwent OPCAB using propensity score matching. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and secondary endpoints were in-hospital outcomes. Accounting for matched-pairs design, the survival analysis was evaluated with a marginal Cox model, and the continuous and dichotomous variables of in-hospital outcomes were compared with the Wilcoxon signed-rank test and a logistic regression model using generalized estimating equations, respectively.
Compared with OPCAB, one-stop HCR was associated with less chest tube drainage (median, 748 mL [interquartile range (IQR), 540-1080 mL] vs 990 mL [IQR, 730-1250 mL]; P < .001), a lower packed red blood cell transfusion rate (18.3% vs 29.6%; P = .032), shorter mechanical ventilation time (median, 13.7 hours [IQR, 10.3-16.9 hours] vs 16.8 hours [IQR, 13.0-19.6 hours]; P < .001), and shorter stay in intensive care unit (median 21.7 hours [IQR, 19.0-44.3 hours] vs 46.7 hours [IQR, 24.3-72.7 hours]; P < .001). Over 30 months of follow-up, one-stop HCR and OPCAB had a similar rate of MACCE (7.4% vs 8.0% at 3 years; hazard ratio, 0.807; 95% confidence limit, 0.352-1.849; P = .612), but one-stop HCR had a lower stroke rate (0% vs 3.6% at 3 years; P = .046).
For selected patients with DM, one-stop HCR provided safe and reproducible revascularization, with less perioperative invasiveness and similar and favorable midterm outcomes compared with OPCAB.
比较糖尿病（DM）患者一站式杂交冠状动脉血运重建术（HCR）和非体外循环冠状动脉搭桥术（OPCAB）后的院内及中期结局。
该系列研究纳入了2007年6月至2014年9月期间在阜外医院接受一站式HCR的120例DM患者。这些患者与240例行OPCAB的患者采用倾向评分匹配，比例为1:2。主要终点是中期随访期间的主要不良心脏或脑血管事件（MACCE），次要终点是院内结局。考虑到配对设计，采用边际Cox模型评估生存分析，并分别使用Wilcoxon符号秩检验和广义估计方程的逻辑回归模型比较院内结局的连续变量和二分变量。
与OPCAB相比，一站式HCR的胸腔引流较少（中位数，748 mL[四分位间距（IQR），540 - 1080 mL] vs 990 mL[IQR，730 - 1250 mL]；P <.001），红细胞压积输血率较低（18.3% vs 29.6%；P =.032），机械通气时间较短（中位数，13.7小时[IQR，10.3 - 16.9小时] vs 16.8小时[IQR，13.0 - 19.6小时]；P <.001），重症监护病房停留时间较短（中位数21.7小时[IQR，19.0 - 44.3小时] vs 46.7小时[IQR，24.3 - 72.7小时]；P <.001）。在30个月的随访中，一站式HCR和OPCAB的MACCE发生率相似（3年时分别为7.4%和8.0%；风险比，0.807；95%置信区间，0.352 - 1.849；P =.612），但一站式HCR的卒中发生率较低（3年时分别为0%和3.6%；P =.046）。
对于选定的DM患者，一站式HCR提供了安全且可重复的血运重建，与OPCAB相比，围手术期侵袭性较小，中期结局相似且良好。
