JACC：一站式复合冠状动脉血运重建术与CABG，PCI对比用于多支血管病变的三年随访结果

北京阜外医院最近一项临床研究，比较一站式复合冠状动脉血运重建术（One-stop hybrid coronary revascularization）与coronary artery bypass grafting（CABG），PCI对比用于多支血管病变的三年随访结果。研究结果表明一站式复合冠状动脉血运重建术对多支血管病变血运重建后疗效良好，EuroSCORE 和SYNTAX 得分明显提高，有望成为PCI和CABG的替代治疗。研究发现一站式复合冠状动脉血运重建术后MACCE明显低于PCI（p<0.001)，与CABG相似。但是根据EuroSCORE or SYNTAX score分层后发现，MACCE发生率在三组中类似。在高SYNTA得分下，采用一站式复合冠状动脉血运重建术低于PCI，与CABG类似。

Abstract

OBJECTIVES:

This study sought to compare midterm clinical outcomes of 1-stop hybrid coronary revascularization (HCR) with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease.

BACKGROUND:

One-stop HCR has emerged to be a feasible and attractive alternative to CABG and PCI in selected patients with multivessel coronary artery disease.

METHODS:

From June 2007 to December 2010, 141 consecutive patients underwent 1-stop HCR at Fuwai Hospital. Using propensity score methodology, these patients were matched with 2 separate groups of 141 patients who underwent isolated CABG or PCI during the same period. All patients were stratified by the EuroSCORE (European System for Cardiac Operative Risk Evaluation Score) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score. Cutoffs for EuroSCORE (low, ≤2; medium, >2 and <6; high, ≥6) and SYNTAX score (low, ≤24; medium, >24 and <30; high, ≥30) were identified by tertiles. Three groups' cumulative major adverse cardiac or cerebrovascular events (MACCE) rates in each risk tertile were compared.

RESULTS:

One-stop HCR incurred MACCE rate lower than that with PCI (p < 0.001), but similar to that with CABG (p = 0.140). After stratification by EuroSCORE or SYNTAX score, the cumulative MACCE rates were similar among the 3 groups in low and medium tertiles. But in the high EuroSCORE tertile, patients who underwent 1-stop HCR had a lower MACCE rate than did the groups that underwent CABG (p = 0.030) and PCI (p = 0.006). Meanwhile, patients with a high SYNTAX score who underwent 1-stop HCR had a MACCE rate lower than did those who underwent PCI (p = 0.002), but similar to that of those who underwent CABG (p = 0.362).

CONCLUSIONS:

One-stop HCR provides favorable midterm outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with high EuroSCORE or SYNTAX score, it might provide a promising alternative to CABG and PCI.