一站式复合再血管化技术治疗冠状动脉多支病变患者的30天预后评估

Comparison on 30-day Clinical Outcome Between Simultaneous Hybrid Coronary Revascularization and Off-pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease

目的:比较一站式复合再血管化技术与非体外循环下冠状动脉旁路移植术(OPCABG)治疗冠状动脉多支病变的术后30天预后结果,探讨一站式复合再血管化技术临床应用安全性及有效性。方法:2009-01至2017-01,在阜外医院接受一站式复合再血管化治疗的冠状动脉多支病变患者共533例(一站式复合技术组)。应用倾向性评分法,筛选同期533例OPCABG患者(OPCABG组)与一站式复合技术组患者进行1:1配对。主要终点事件为术后30天主要不良心脑血管事件(MACCE);次要终点为术后住院结果,包括术后胸管总引流量,血制品使用率,术后呼吸机使用时间、重症监护室(ICU)停留时间等。结果:与OPCABG组相比,一站式复合技术组术后胸管总引流量[714(523,971)ml vs 965(716,1 220)ml,P<0.001]显著减少,降低了血制品使用率(19.7%vs 34.0%,P=0.024),缩短了呼吸机使用时间[12.6(9.3,15.7)h vs16.0(12.8,18.7)h,P<0.001]和ICU停留时间[21.7(19.8,42.4)h vs 41.6(23.6,70.0)h,P<0.001];术后30天全因死亡率、心肌梗死、脑血管事件、再血管化事件及总体MACCE发生率差异均无统计学意义。结论:对于冠状动脉多支病变患者,一站式复合再血管化技术提供了另一种安全、有效的治疗选择;与OPCABG相比,创伤减少,早期治疗效果相似。

Objectives： The purpose of this study was to compare the 30-day clinical outcome after simultaneous hybrid coronary revascularization（HCR） with off-pump coronary artery bypass grafting（OPCABG） in patients with multivessel coronary artery disease and evaluate the safety and efficiency of simultaneous hybrid coronary revascularization strategy.Methods： Simultaneous HCR was performed in 533 patients with multivessel coronary artery disease at Fuwai hospital from January 2009 to January 2017. These patients were 1：1 matched with patients underwent OPCABG using propensity score matching method. The primary endpoint was major adverse cardiac or cerebrovascular events（MACCE） over the 30-day follow-up post-surgery, and the second endpoints were in-hospital outcomes, including chest tube drainage, transfusion rate, mechanical ventilation time and length of stay in intensive care unit. Results： Chest tube drainage post-surgery（ml）（714 [523, 971] vs 965 [716, 1 220], P〈0.001）,Blood transfusion rate（19.7% vs 34.0%, P=0.024）, mechanical ventilation time（hours）（12.6[9.3, 15.7] vs 16.0 [12.8, 18.7], P〈0.001）, and stay in intensive care unit（hours）（21.7[19.8, 42.4] vs 41.6[23.6, 70.0], P〈0.001） were all significantly reduced in the simultaneous HCR group than in OPCABG group. Mortality, myocardial infarction, stroke, repeat revascularization rate and accumulated MACCE rate during the 30-day follow-up were similar between HCR group and OPCABG group.Conclusions： For selected patients with multivessel coronary artery disease, simultaneous HCR provided a safe and effective alternative revascularization strategy. Simultaneous HCR is associated with less blood loss, faster recovery, and fewer perioperative complications and achieved similar and favorable early outcomes as compared with OPCABG strategy.