一站式复合技术与冠状动脉旁路移植术及经皮冠状动脉介入治疗在冠状动脉多支病变治疗中的对比研究

Comparative Study of One-stop Hybrid Technology, Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Treating Patients With Multivessel Coronary Artery Disease

目的:比较一站式复合技术与冠状动脉(冠脉)旁路移植术(CABG)及经皮冠脉介入治疗(PCI)对不同风险层次冠脉多支病变的中远期临床治疗结果,探讨一站式复合技术最佳临床应用指征。方法:自2007-06至2010-12在阜外医院接受一站式复合冠脉血运重建术的冠脉多支病变患者共141例(一站式复合技术组)。同期共5 797例多支病变患者行CABG,4 254例多支病变患者行PCI,对术前主要危险因素进行Logistic回归分析计算倾向性评分,采用最邻近配比法各选择141例CABG患者(CABG组)及PCI患者(PCI组)与一站式复合技术组患者进行1:1配对。应用Euro SCORE及SYNTAX评分对采用三种不同治疗方法的患者进行风险分层(Euro SCORE低危患者≤2分,中危患者3~5分,高危患者≥6分;SYNTAX评分低危患者≤24分,中危患者25~29分,高危患者≥30分),分别比较采用3种不同再血管化治疗方式的Euro SCORE低、中、高危患者及SYNTAX评分低、中、高危患者随访期间主要不良心脑血管事件(MACCE)发生率。结果:至2015-01,平均随访时间为4.5年。一站式复合技术组总体MACCE发生率(9.9%)显著低于PCI组(27.7%,P<0.001),但与CABG组(19.1%)比较差异无统计学意义(P=0.150)。采用Euro SCORE对三组患者进行风险分层后,在Euro SCORE低危及中危患者中,一站式复合技术组MACCE发生率与CABG组、PCI组比较差异无统计学意义;在Euro SCORE高危患者中,一站式复合技术组MACCE发生率均显著低于CABG组(P=0.017)和PCI组(P<0.001)。采用SYNTAX评分对三组患者进行风险分层,在SYNTAX评分低危及中危患者中,一站式复合技术组MACCE发生率与CABG组、PCI组比较差异无统计学意义;在SYNTAX评分高危患者中,一站式复合技术组MACCE发生率显著低于PCI组(P<0.001),与CABG组相比差异无统计学意义(P=0.355)。结论:一站式复合技术治疗不同风险层次冠脉多支病变均取得了较好中远期临床效果,对于临床上具有常规再血管化治疗高危因素的患者,一站式复合技术提供了另一种安全可行的再血管化治疗策略。

Objective： To compare the middle and long term clinical outcomes of one-stop hybrid coronary revascularization, coronary artery bypass grafting（CABG） and percutaneous coronary intervention（PCI） in treating the patients with multivessel coronary artery disease; to explore the optimal indication of one-stop hybrid technology. Methods： Our research included in 3 groups： Hybrid group, n =141 patients received one-stop hybrid coronary revascularization in our hospital from 2006-06 to 2010-16. Meanwhile, 5 797 patients received CABG and 4 254 received PCI, the major pre-operative risk factors were studied by Logistic regression analysis to calculate propensity score, adjacent matching was used to respectively select 141 subjects from CABG and PCI patients to make 1：1 match with Hybrid groupas CABG group and PCI group. Euro SCORE and SYNTAX score were used to make risk stratification in all 3 groups. By Euro SCORE system： low risk ≤ 2, medium risk（3-5） and high risk ≥ 6; by SYNTAX score system： low risk ≤ 24, medium risk（25-29） and high risk ≥ 30. The incidence of major adverse cardiac/cerebral vascular events（MACCE） was compared among 3 groups at different risk stratifications.Results： The mean follow-up time was 4.5 years up to 2015-01. The overall incidence of MACCE was lower in Hybrid group（9.9%） than PCI group（27.7%）, P〈0.001; while it was similar between Hybrid group and CABG group（19.1%）, P =0.150. By Euro SCORE stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than both CABG group（P =0.017） and PCI group（P〈0.001）. By SYNTAX score stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than PCI group（P〈0.001）, it was similar between Hybrid group and CABG group（P =0.355）.Conclusion： One-stop hybrid technology had the better middle and long term outcomes for treating multivessel coronary artery disease patients with high risk stratification, which provided an alternative strategy in clinical practice.