＂一站式＂复合再血管化与经皮冠状动脉介入术治疗冠状动脉多支病变中期造影随访研究

＂One-stop＂ hybrid coronary revascularization and percutaneous coronary intervention for the treatment of multivessel coronary artery disease： A propensity score matching analysis

目的 通过冠状动脉造影比较＂一站式＂复合再血管化技术（Hybrid技术）与经皮冠状动脉介入术（PCI）治疗冠状动脉多支病变的靶血管及旁路通畅率.方法 2007年6月至2009年12月我院实施＂一站式＂复合再血管化104例,冠状动脉介入治疗7165例.研究病例分为两组,Hybrid组和PCI组.入选标准：①合并前降支（LAD）病变的冠状动脉多支病变患者;②随访期间无胸痛等不适主诉、无心血管不良事件、无住院治疗、症状药物控制良好的患者;③外科术者和介入术者均为经验丰富的医生.按照上述标准,电话随访同意接受造影复查的患者Hybrid组102例,PCI组157例.2010年10月至2011年12月,50例Hybrid患者完成造影复查;采用倾向性评分1∶1匹配的统计方法抽取PCI组患者50例,完成冠状动脉造影检查.研究终点是两组患者冠状动脉造影随访的靶血管通畅率及二次血运重建率.结果 Hybrid组和PCI组各50例,随访时间分别为（18.0±8.0）个月和（19.3±9.1）个月.两组患者基线特征差异无统计学意义.Hybrid组LIMA-LAD旁路通畅率显著高于PCI组LAD靶血管通畅率（98%比80%,P＝0.004）;Hybrid组的LIMA旁路二次血运重建率显著低于PCI组LAD靶血管二次血运重建率（2%比20%,P＝0.008）.结论 ＂一站式＂复合再血管化技术使冠状动脉多支病变能获得良好的中期靶血管通畅率,其LIMA-LAD旁路通畅率显著优于PCI技术前降支药物洗脱支架通畅率.

Objective This study was designed to compare the bypass patency between ＂one-stop＂ hy- brid coronary revascularization and PCI in the treatment of coronary artery multi-vessel disease with the aid of mid-term coronary angiography. Methods In Fuwai hospital from June 2007 to December 2009, 104 cases under-went ＂one-stop＂ hybrid coronary revaseularization and 7165 cases underwent PCI. The inclusion criteria are：（1） triple vessel disease combined anterior descending artery （LAD） coronary artery lesions. （2）No chest pain, no MACCE during following-up. （3） The doctors were experienced ones. Based on the above requirements, finally pa-tients who were agreed to take angiography check were 102 hybrid cases and 157 PCI cases, respectively. From October, 2010 to December, 2011, as many as 50 hybrid patients signed the agreement and underwent angiogra- phy. Among the 157 PCI cases, 50 cases of each were selected for coronary angiography with the use of propensity score 1：1 matching method. Results The hybrid group and the PC1 group, the follow-up time was （18.0±8.0） months and （19.3±9.1） months. There were no significant differences in baseline characteristics among the three groups of patients. There were 50 LIMA bypasses and 64 non-LAD target vessels in hybrid group, and the imaging results showed a target vessel patency rate of 89.5%, and a revascularization rate of 7.9%. In PCI group, angiogra- phy showed a target vessel pateney rate of 82.7%, and a revascularization rate of 20.4%. The coronary angiographyresults showed no significant difference in overall patency between the hybrid group and PCI group （89.5% vs 82.7%, P=0.07 ）, a significantly higher patency rate in hybrid LIMA-LAD bypass group over the PCI LAD target vessel group （98% vs 80%, P=0.004）, no significant difference in non-LAD target vessel patency between the two （82.8% vs 85.2%, P=0.727 ）. Conclusion For the ＂one-stop＂ hybrid revascularization treatment of coronary artery multi-vessel disease, its LIMA-LAD bypass patency rate is significantly superior to the DES pateney rate of PCI with LAD and the non-LAD patency of ＂one-stop＂ hybrid revaseularization group with DES is similar to that of PCI.