Basman Craig, Hemli Jonathan M, Kim Michael C, Seetharam Karthik, Brinster Derek R, Pirelli Luigi, Kliger Chad A, Scheinerman S Jacob, Singh Varinder P, Patel Nirav C
Department of Cardiovascular Medicine, Lenox Hill Hospital/Northwell Health, New York, New York.
Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.
J Card Surg. 2020 Oct;35(10):2710-2718. doi: 10.1111/jocs.14891. Epub 2020 Jul 28.
Hybrid coronary revascularization (HCR) constitutes a left internal mammary artery graft to the left anterior descending (LAD) coronary artery, coupled with percutaneous coronary intervention (PCI) for non-LAD lesions. This management strategy is not commonly offered to patients with complex multivessel disease. Our objective was to evaluate 8-year survival in patients with triple-vessel disease (TVD) treated by HCR, compared with that of concurrent matched patients managed by traditional coronary artery bypass grafting (CABG) or multivessel PCI.
A retrospective review was undertaken of 4805 patients with TVD who presented between January 2009 and December 2016. A cohort of 100 patients who underwent HCR were propensity-matched with patients treated by CABG or multivessel PCI. The primary endpoint was all-cause mortality at 8 years.
Patients with TVD who underwent HCR had similar 8-year mortality (5.0%) as did those with CABG (4.0%) or multivessel PCI (9.0%). A composite endpoint of death, repeat revascularization, and new myocardial infarction, was not significantly different between patient groups (HCR 21.0% vs CABG 15.0%, P = .36; HCR 21.0% vs PCI 25.0%, P = .60). Despite a higher baseline synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX) score, HCR was able to achieve a lower residual SYNTAX score than multivessel PCI (P = .001).
In select patients with TVD, long-term survival and FREEDOM from major adverse cardiovascular events after HCR are similar to that seen after traditional CABG or multivessel PCI. HCR should be considered for patients with multivessel disease, presuming a low residual SYNTAX score can be achieved.
杂交冠状动脉血运重建术（HCR）包括将左乳内动脉移植至左前降支（LAD）冠状动脉，同时对非LAD病变进行经皮冠状动脉介入治疗（PCI）。这种治疗策略通常不会提供给患有复杂多支血管病变的患者。我们的目的是评估接受HCR治疗的三支血管病变（TVD）患者的8年生存率，并与同期接受传统冠状动脉旁路移植术（CABG）或多支血管PCI治疗的匹配患者进行比较。
对2009年1月至2016年12月期间出现的4805例TVD患者进行回顾性研究。100例接受HCR的患者队列与接受CABG或多支血管PCI治疗的患者进行倾向匹配。主要终点是8年时的全因死亡率。
接受HCR治疗的TVD患者的8年死亡率（5.0%）与接受CABG治疗的患者（4.0%）或多支血管PCI治疗的患者（9.0%）相似。患者组之间死亡、再次血运重建和新发心肌梗死的复合终点无显著差异（HCR为21.0%，CABG为15.0%，P = 0.36；HCR为21.0%，PCI为25.0%，P = 0.60）。尽管紫杉醇药物洗脱支架冠状动脉介入治疗与心脏手术（SYNTAX）评分的基线协同性较高，但HCR能够比多支血管PCI获得更低的残余SYNTAX评分（P = 0.001）。
在特定的TVD患者中，HCR术后的长期生存率和主要不良心血管事件的发生率与传统CABG或多支血管PCI相似。对于多支血管病变患者，如果能获得较低的残余SYNTAX评分，则应考虑HCR。
