药物洗脱支架或冠状动脉搭桥手术治疗左主干病变试验中内镜取静脉与开放取静脉的比较

Endoscopic vs Open Vein Harvest in Drug-Eluting Stents or Bypass Surgery for Left Main Disease Trial.

作者信息

Jarrett Craig M, Pelletier Marc, Abu-Omar Yasir, Baeza Cristian, Elgudin Yakov, Markowitz Alan, Vega Pablo Ruda, Dressler Ovidiu, Kappetein Arie Pieter, Serruys Patrick W, Stone Gregg W, Sabik Joseph F

机构信息

Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.

Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.

出版信息

Ann Thorac Surg. 2023 Jan;115(1):72-78. doi: 10.1016/j.athoracsur.2021.12.079. Epub 2022 Mar 11.

DOI:10.1016/j.athoracsur.2021.12.079

PMID:35283098

Abstract

BACKGROUND

We investigated outcomes of coronary artery bypass grafting (CABG) with endoscopic vein harvest (EVH) vs open vein harvest (OVH) within the Evaluation of XIENCE Versus CABG (EXCEL) trial.

METHODS

All patients in EXCEL randomized to CABG were included in this study. For this analysis, the primary end points were ischemia-driven revascularization (IDR) and graft stenosis or occlusion at 5 years. Additional end points were as follows: a composite of death from any cause, stroke, or myocardial infarction; bleeding; blood product transfusion; major arrhythmia; and infection requiring antibiotics. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses.

RESULTS

Of the 957 patients randomized to CABG, 686 (71.7%) received at least 1 venous graft with 257 (37.5%) patients in the EVH group and 429 (62.5%) patients in the OVH group. At 5 years, IDR was higher (11.5% vs 6.7%; P = .047) in the EVH group. At 5 years, rates of graft stenosis or occlusion (9.7% vs 5.4%; P = .054) and the primary end point (17.4% vs 20.9%; P = .27) were similar. In-hospital bleeding (11.3% vs 13.8%; P = .35), in-hospital blood product transfusion (12.8% vs 13.1%; P = .94), and infection requiring antibiotics within 1 month (13.6% vs 16.8%; P = .27) were similar between EVH and OVH patients. Major arrhythmia in the hospital (19.8% vs 13.5%; P = .03) and within 1 month (21.8% vs 15.4%; P = .03) was higher in EVH patients.

CONCLUSIONS

IDR at 5 years was higher in the EVH group. EVH and OVH patients had similar rates of graft stenosis or occlusion and the composite of death, stroke, or myocardial infarction at 5 years.

摘要

背景

在XIENCE与冠状动脉旁路移植术（CABG）评估（EXCEL）试验中，我们研究了采用内镜下静脉采集（EVH）与开放静脉采集（OVH）进行冠状动脉旁路移植术（CABG）的结果。

方法

EXCEL试验中所有随机分配接受CABG的患者均纳入本研究。对于本分析，主要终点为缺血驱动的血运重建（IDR）和5年时移植血管狭窄或闭塞。其他终点如下：任何原因导致的死亡、中风或心肌梗死的复合终点；出血；血液制品输注；严重心律失常；以及需要使用抗生素治疗的感染。事件发生率基于首次事件时间分析中的Kaplan-Meier估计值。

结果

在957例随机接受CABG的患者中，686例（71.7%）接受了至少1条静脉移植物，其中EVH组257例（37.5%），OVH组429例（62.5%）。5年时，EVH组的IDR更高（11.5%对6.7%；P = .047）。5年时，移植血管狭窄或闭塞率（9.7%对5.4%；P = .054）和主要终点（17.4%对20.9%；P = .27）相似。EVH组和OVH组患者的院内出血（11.3%对13.8%；P = .35）、院内血液制品输注（12.8%对13.1%；P = .94）以及1个月内需要使用抗生素治疗的感染（13.6%对16.8%；P = .27）相似。EVH组患者的院内严重心律失常（19.8%对13.5%；P = .03）和1个月内（21.8%对15.4%；P = .03）更高。