真实世界中多支冠状动脉疾病患者杂交冠状动脉血运重建与传统冠状动脉搭桥手术的比较：住院结局及中期随访：COHOS研究
Comparison of hybrid coronary revascularization versus conventional Coronary Artery Bypass surgery in patients with multi-vessel coronary artery disease in a real-world setting: In-hospital outcomes and medium-term follow-up: COHOS study.
作者信息
Kaliyamoorthy Dhamodaran, Mohamed Yusuf Meeranghani, Ramalingam Vadivelu, Kasha Abhishek, Kathiresan Manickam, Suliankatchi Abdulkader Rizwan, Kathiresan Jeyashree, Mahesh Kumar Aishwarya, Grace Elsa, Choudhury Anirban
机构信息
Apollo Hospitals, Greams Road, Chennai - 600006, India.
Apollo Hospitals, Greams Road, Chennai - 600006, India.
出版信息
Indian Heart J. 2025 Mar-Apr;77(2):98-104. doi: 10.1016/j.ihj.2025.03.002. Epub 2025 Mar 5.
OBJECTIVES
The aim of this observational study was to evaluate the in-hospital and medium-term outcomes of hybrid coronary revascularization (HCR) in the real-world setting compared to conventional coronary artery bypass grafting (CABG).
METHODS
All patients with multi-vessel coronary artery disease (MV-CAD) who underwent conventional CABG and HCR in our institution between January 2018 to January 2021 were evaluated in terms of length of intensive care unit (ICU), in-hospital stay, repeat revascularization rates, bleeding, stroke, and in-hospital mortality. Clinical outcomes (mortality and major adverse cardiac and cerebrovascular events [MACCE]) were assessed at average follow up of 3.6 years.
RESULTS
Pre-procedural characteristics were balanced between the groups after propensity score matching. There was no significant difference in MACCE [Odds ratio: 0.57; 95 % CI: 0.05 to 1.52; p = 0.66], in-hospital mortality [n = 2 (1.9 %) vs n = 0; p = 0.80], post procedure stroke [n = 2 (1.9 %) vs n = 2 (3.7 %); p = 0.86], post-procedural myocardial infarction requiring repeat revascularization [n = 2 (1.9 %) versus n = 1 (1.9 %); p = 1] during the in-hospital stay of the patients in the CABG vs HCR groups respectively. HCR was associated with significantly lower requirement for blood transfusions, bleeding risk, in-hospital stay, and intensive care unit stay. Analysis of the outcomes after 3.6 years revealed no significant difference in MACCE [Odds ratio: 1.40; 95 % CI: 0.46 to 4.30; p = 0.55], and post discharge mortality [n = 0 vs n = 0; p = 1]. Both groups had similar rates of post-procedural myocardial infarction requiring repeat revascularization [n = 0 vs n = 4 (7.4 %); p = 0.278], and rate of re-intervention [n = 0 vs n = 3 (5.6 %); p = 0.41].
CONCLUSION
HCR may be considered as a safe and feasible alternative to conventional CABG in selected individuals with MV-CAD.
目的
本观察性研究旨在评估在现实环境中，与传统冠状动脉旁路移植术（CABG）相比，杂交冠状动脉血运重建术（HCR）的院内及中期结局。
方法
对2018年1月至2021年1月期间在我院接受传统CABG和HCR的所有多支冠状动脉疾病（MV-CAD）患者，就重症监护病房（ICU）时长、住院时间、再次血运重建率、出血、中风及院内死亡率进行评估。在平均3.6年的随访中评估临床结局（死亡率及主要不良心脑血管事件[MACCE]）。
结果
倾向得分匹配后，两组术前特征均衡。CABG组与HCR组患者在住院期间，MACCE[比值比：0.57；95%可信区间：0.05至1.52；p = 0.66]、院内死亡率[n = 2（1.9%）对n = 0；p = 0.80]、术后中风[n = 2（1.9%）对n = 2（3.7%）；p = 0.86]、术后需要再次血运重建的心肌梗死[n = 2（1.9%）对n = 1（1.9%）；p = 1]方面均无显著差异。HCR与输血需求、出血风险、住院时间及重症监护病房停留时间显著降低相关。3.6年后结局分析显示，MACCE[比值比：1.40；95%可信区间：0.46至4.30；p = 0.55]及出院后死亡率[n = 0对n = 0；p = 1]无显著差异。两组术后需要再次血运重建的心肌梗死发生率[n = 0对n = 4（7.4%）；p = 0.278]及再次干预率[n = 0对n = 3（5.6%）；p = 0.41]相似。
结论
对于部分MV-CAD患者，HCR可被视为传统CABG的一种安全可行的替代方案。
Zotero 插件