1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.
2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany.
Eur Heart J Acute Cardiovasc Care. 2019 Jun;8(4):360-368. doi: 10.1177/2048872617717687. Epub 2017 Jun 29.
While coronary artery bypass grafting remains the standard treatment of complex multivessel coronary artery disease, the advent of peripheral ventricular assist devices has enhanced the safety of percutaneous coronary intervention. We therefore evaluated the safety in terms of inhospital outcome comparing protected high-risk percutaneous coronary intervention with the Impella 2.5 device and coronary artery bypass grafting in patients with complex multivessel coronary artery disease.
This retrospective study included patients with complex multivessel coronary artery disease (SYNTAX score >22) undergoing either coronary artery bypass grafting before the implementation of a protected percutaneous coronary intervention programme with a peripheral ventricular assist device or protected percutaneous coronary intervention with the Impella 2.5 device following the start of the programme. The primary endpoint consisted of inhospital major adverse cardiac and cerebrovascular events. The combined secondary endpoint included peri and post-procedural adverse events.
A total of 54 patients (mean age 70.1±9.9 years, 92.6% men) were enrolled in the study with a mean SYNTAX score of 34.5±9.8. Twenty-six (48.1%) patients underwent protected percutaneous coronary intervention while 28 (51.9%) patients received coronary artery bypass grafting. The major adverse cardiac and cerebrovascular event rate was numerically higher in the coronary artery bypass grafting group (17.9 vs. 7.7%; =0.43) but was not statistically significant. The combined secondary endpoint was not different between the groups; however, patients undergoing coronary artery bypass grafting experienced significantly more peri-procedural adverse events (28.6 vs. 3.8%; <0.05).
Patients with complex multivessel coronary artery disease undergoing protected percutaneous coronary intervention with the Impella 2.5 device experience similar intrahospital major adverse cardiac and cerebrovascular event rates when compared to coronary artery bypass grafting. Protected percutaneous coronary intervention represents a safe alternative to coronary artery bypass grafting in terms of inhospital adverse events.
虽然冠状动脉旁路移植术仍然是治疗复杂多支冠状动脉疾病的标准治疗方法，但外周心室辅助装置的出现提高了经皮冠状动脉介入治疗的安全性。因此，我们评估了在因保护高危经皮冠状动脉介入治疗与 Impella 2.5 装置和复杂多支冠状动脉疾病患者的冠状动脉旁路移植术比较的住院期间结果方面的安全性。
这项回顾性研究包括接受保护高危经皮冠状动脉介入治疗与 Impella 2.5 装置的复杂多支冠状动脉疾病患者（SYNTAX 评分>22），这些患者在启动外周心室辅助装置的保护经皮冠状动脉介入治疗方案之前接受了冠状动脉旁路移植术，或者在启动该方案后接受了保护经皮冠状动脉介入治疗与 Impella 2.5 装置。主要终点包括住院期间主要心脏和脑血管不良事件。联合次要终点包括围手术期和手术后不良事件。
共有 54 名患者（平均年龄 70.1±9.9 岁，92.6%为男性）入组研究，平均 SYNTAX 评分为 34.5±9.8。26 名（48.1%）患者接受了保护经皮冠状动脉介入治疗，而 28 名（51.9%）患者接受了冠状动脉旁路移植术。冠状动脉旁路移植术组的主要心脏和脑血管不良事件发生率较高（17.9%比 7.7%；=0.43），但无统计学意义。两组联合次要终点无差异；然而，接受冠状动脉旁路移植术的患者经历的围手术期不良事件明显更多（28.6%比 3.8%；<0.05）。
与冠状动脉旁路移植术相比，接受 Impella 2.5 装置保护高危经皮冠状动脉介入治疗的复杂多支冠状动脉疾病患者的住院期间主要心脏和脑血管不良事件发生率相似。在住院期间不良事件方面，保护高危经皮冠状动脉介入治疗是冠状动脉旁路移植术的安全替代方法。
