Zhu Pengxiong, Qiu Jiapei, Xu Hong, Liu Jun, Zhao Qiang
Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Transl Med. 2021 Feb;9(4):285. doi: 10.21037/atm-20-4224.
Hybrid coronary revascularization (HCR) has a similar clinical outcome to coronary artery bypass grafting (CABG) in treating multivessel disease. However, the outcome of HCR in treating left main coronary artery (LM) disease is unclear. This study sought to compare the clinical outcome of HCR with total arterial revascularization (TAR) for treating LM disease.
Patients who underwent treatment for LM disease in our center between January 2009 and December 2019 were selected. Of these, 33 patients underwent HCR, and 70 patients underwent TAR. The primary efficacy outcome of this study was mid-term major adverse cardiac and cerebrovascular events (MACCE). The primary safety outcome was perioperative MACCE.
The incidence of postoperative outcomes was comparable between the two groups after adjustment with inverse probability weighting (IPW) (P>0.05). The median follow-up time was 47 (interquartile range, 20 to 85) months. There was no significant difference in the incidence of all mid-term outcomes and the freedom of MACCE between the two groups after adjustment (P>0.05). The Cox proportional hazard model demonstrated that HCR was not a significant determinant for MACCE [hazard ratio (HR) =3.516, 95% confidence interval (CI): 0.835 to 14.813].
HCR may be safe and effective for the treatment of LM disease compared with TAR.
杂交冠状动脉血运重建术（HCR）在治疗多支血管病变方面具有与冠状动脉旁路移植术（CABG）相似的临床结局。然而，HCR治疗左主干冠状动脉（LM）疾病的结局尚不清楚。本研究旨在比较HCR与全动脉血运重建术（TAR）治疗LM疾病的临床结局。
选取2009年1月至2019年12月在本中心接受LM疾病治疗的患者。其中，33例患者接受了HCR，70例患者接受了TAR。本研究的主要疗效结局是中期主要不良心脑血管事件（MACCE）。主要安全结局是围手术期MACCE。
经逆概率加权（IPW）调整后，两组术后结局的发生率相当（P>0.05）。中位随访时间为47（四分位间距，20至85）个月。调整后，两组所有中期结局的发生率和MACCE的无事件生存率无显著差异（P>0.05）。Cox比例风险模型显示，HCR不是MACCE的显著决定因素[风险比（HR）=3.516，95%置信区间（CI）：0.835至14.813]。
与TAR相比，HCR治疗LM疾病可能是安全有效的。
