Ahmad Fraz, Khan Alamgir Aslam, Aslam Ameer, Sajid Talha Bin, Amjad Aqsa, Parveen Aamira, Hassan Shahzaib, Qammar Bilal, Ullah Rafi
Cardiology, Shalamar Hospital, Lahore, PAK.
Internal Medicine, Shalamar Hospital, Lahore, PAK.
Cureus. 2024 Oct 3;16(10):e70769. doi: 10.7759/cureus.70769. eCollection 2024 Oct.
BACKGROUND: Acute ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular condition requiring timely intervention to restore coronary blood flow and minimize myocardial damage. While percutaneous coronary intervention (PCI) remains the gold standard, it is often insufficient for patients with complex coronary anatomy, such as multivessel disease or left main coronary artery involvement. Hybrid coronary revascularization (HCR), which combines PCI and coronary artery bypass grafting (CABG), offers a novel approach to managing these complex cases. OBJECTIVE: The primary objective of this study was to evaluate the outcomes of HCR in patients presenting with acute STEMI, particularly those with high-risk features such as multivessel disease or left main coronary artery involvement. METHODS: This prospective cohort study was conducted at Shalamar Hospital, a tertiary care center in Lahore, Pakistan. The study enrolled 342 patients diagnosed with acute STEMI between January 1, 2023, and December 31, 2023. Participants underwent HCR, consisting of PCI with drug-eluting stents and minimally invasive CABG. Key outcomes included the incidence of major adverse cardiovascular events (MACE) within one year, graft patency at six months, and overall procedural success. Data were collected through patient records and follow-up assessments, and statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). RESULTS: The one-year MACE rate was 14.6%, with 6.1% of patients experiencing myocardial infarction, 4.4% requiring repeat revascularization, and 4.1% experiencing cardiac death. Graft patency at six months was 94.7%, and the overall procedural success rate was 98.2%. One-year survival was observed in 95.3% of the patients. CONCLUSION: HCR is a safe and effective strategy for managing acute STEMI, particularly in patients with complex coronary anatomy. It offers a balanced approach by reducing the need for invasive procedures and improving patient outcomes. Further multicenter studies are necessary to confirm these findings and establish standardized guidelines for HCR.
背景：急性ST段抬高型心肌梗死（STEMI）是一种危急的心血管疾病，需要及时干预以恢复冠状动脉血流并将心肌损伤降至最低。虽然经皮冠状动脉介入治疗（PCI）仍然是金标准，但对于冠状动脉解剖结构复杂的患者，如多支血管病变或左主干冠状动脉受累患者，往往并不足够。混合冠状动脉血运重建术（HCR），即将PCI与冠状动脉旁路移植术（CABG）相结合，为处理这些复杂病例提供了一种新方法。 目的：本研究的主要目的是评估HCR在急性STEMI患者中的疗效，尤其是那些具有多支血管病变或左主干冠状动脉受累等高风险特征的患者。 方法：这项前瞻性队列研究在巴基斯坦拉合尔的一家三级医疗中心沙勒马尔医院进行。该研究纳入了2023年1月1日至2023年12月31日期间诊断为急性STEMI的342例患者。参与者接受了HCR，包括药物洗脱支架PCI和微创CABG。主要结局包括一年内主要不良心血管事件（MACE）的发生率、六个月时移植血管通畅率以及总体手术成功率。通过患者记录和随访评估收集数据，并使用SPSS Statistics 26.0版（IBM公司。2019年发布。适用于Windows的IBM SPSS Statistics，版本26.0。纽约州阿蒙克：IBM公司）进行统计分析。 结果：一年的MACE发生率为14.6%，其中6.1%的患者发生心肌梗死，4.4%的患者需要再次血运重建，4.1%的患者发生心源性死亡。六个月时移植血管通畅率为94.7%，总体手术成功率为98.2%。95.3%的患者观察到一年生存率。 结论：HCR是治疗急性STEMI的一种安全有效的策略，尤其是在冠状动脉解剖结构复杂的患者中。它通过减少侵入性手术的需求并改善患者结局提供了一种平衡的方法。需要进一步的多中心研究来证实这些发现并建立HCR的标准化指南。
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