Hannan Edward L, Wu Yi-Feng, Cozzens Kimberly, Tamis-Holland Jacqueline, Ling Frederick S K, Jacobs Alice K, Venditti Ferdinand J, Berger Peter B, Walford Gary, King Iii Spencer B
University at Albany, State University of New York, Albany, NY, USA.
Mount Sinai St. Luke's Hospital, New York, NY, USA.
J Geriatr Cardiol. 2021 Mar 28;18(3):159-167. doi: 10.11909/j.issn.1671-5411.2021.03.003.
Hybrid coronary revascularization (HCR) combines a minimally invasive surgical approach to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) for non-LAD diseased coronary arteries. It is associated with shorter hospital lengths of stay and recovery times than conventional coronary artery bypass surgery, but there is little information comparing it to isolated PCI for multivessel disease. Our objective is to compare long-term outcomes of HCR and PCI for patients with multivessel disease.
This cohort study used data from New York's cardiac surgery and PCI registries in 2010-2016 to examine mortality and repeat revascularization rates for patients with multivessel coronary artery disease who underwent HCR and PCI. Cox proportional hazards methods were used to reduce selection bias. Patients were followed for a median of four years.
There was a total of 335 HCR patients (1.2%) and 25,557 PCI patients (98.8%) after exclusions. There was no difference in 6-year risk adjusted survival between HCR and PCI patients (83.17% . 81.65%, adjusted hazard ratio (aHR) = 0.90 (95% CI: 0.67-1.20). However, HCR patients were more likely to be free from repeat revascularization in the LAD artery (91.13% . 83.59%, aHR = 0.51 (95% CI: 0.34-0.77)).
For patients with multi-vessel coronary artery disease, HCR is rarely performed. There are no differences in mortality rates after four years, but HCR is associated with lower repeat revascularization rates in the LAD artery, presumably due to better longevity in left arterial mammary grafts.
杂交冠状动脉血运重建术（HCR）将左前降支（LAD）动脉的微创外科手术方法与非LAD病变冠状动脉的经皮冠状动脉介入治疗（PCI）相结合。与传统冠状动脉搭桥手术相比，它与更短的住院时间和恢复时间相关，但与单纯PCI治疗多支血管疾病相比，相关信息较少。我们的目的是比较HCR和PCI治疗多支血管疾病患者的长期疗效。
这项队列研究使用了2010 - 2016年纽约心脏外科手术和PCI登记处的数据，以检查接受HCR和PCI的多支冠状动脉疾病患者的死亡率和再次血运重建率。采用Cox比例风险方法以减少选择偏倚。对患者进行了为期四年的中位数随访。
排除后，共有335例HCR患者（1.2%）和25557例PCI患者（98.8%）。HCR和PCI患者的6年风险调整生存率无差异（83.17%对81.65%，调整后风险比（aHR）=0.90（95%CI：0.67 - 1.20））。然而，HCR患者更有可能免于LAD动脉再次血运重建（91.13%对83.59%，aHR = 0.51（95%CI：0.34 - 0.77））。
对于多支冠状动脉疾病患者，HCR很少进行。四年后的死亡率没有差异，但HCR与LAD动脉较低的再次血运重建率相关，可能是由于左动脉乳腺移植物的寿命更长。
