Abstract

Objectives

Evaluation of 3-year clinical outcome of hybrid myocardial revascularization (HMR) compared to conventional revascularization strategies in patients with multivessel coronary artery disease involving the proximal left anterior descending artery. Design. Retrospective matched cohort study based on a prospective feasibility study including 103 elective patients undergoing staged HMR from October 2010 until February 2012. The Western Denmark Heart Registry was used to identify patients who underwent coronary artery bypass grafting (CABG) and multivessel percutaneous coronary intervention (PCI) by matching on number of diseased vessels, age and comorbidity score. Primary endpoint was the composite rate of major adverse cardiovascular and cerebrovascular events (MACCE) at 3-year follow-up. Secondary endpoints included individual MACCE components, acute kidney injury, and cardiovascular readmissions. Results. There was no difference between MACCE in the three groups (HMR 31.1%; CABG 20.4%; PCI 20.4%, p = .11). Estimates of repeat revascularization were significantly increased with HMR versus CABG. In the CABG group, fewest patients required cardiovascular readmissions though with the highest incidence of acute kidney injury. Conclusions. HMR was not superior with respect to MACCE compared with CABG and PCI. It may, however, represent a safe alternative to conventional revascularization treatment considering the specific procedure-associated morbidity.

中文翻译：

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与传统血管重建术相比，杂合子治疗多支冠状动脉疾病的结果

摘要

目标

与传统的血运重建策略相比，在涉及左前降支近端的多支冠状动脉疾病患者中评估了混合心肌血运重建（HMR）的3年临床结果。设计。基于前瞻性可行性研究的回顾性配对队列研究，包括从2010年10月至2012年2月接受分期HMR的103例择期患者。西丹麦心脏注册中心用于确定接受冠状动脉搭桥术（CABG）和多支血管经皮冠状动脉介入治疗（PCI）的患者），以匹配患病血管的数量，年龄和合并症评分。主要终点是3年随访中主要不良心血管和脑血管事件（MACCE）的综合发生率。次要终点包括单个MACCE组件，急性肾损伤和心血管再入院。结果。三组的MACCE之间无差异（HMR 31.1％; CABG 20.4％; PCI 20.4％，p = .11）。HMR与CABG相比，重复血运重建的估计显着增加。在CABG组中，尽管急性肾损伤的发生率最高，但需要心血管再入院的患者最少。结论。与CABG和PCI相比，HMR在MACCE方面并不优越。但是，考虑到与具体手术相关的发病率，它可能是常规血运重建治疗的安全替代方案。