| Objective:"One-stop" hybrid coronary revascularization has emerged to be a reliable and attractive solution in the international cardiovascular field for selective patients with multi-vessel coronary artery disease. However, so far, there has been neither midterm nor long term angiogram result of the surgery. This study seeks to analyze our midterm angiogram results of the "one-stop" hybrid coronary revascularization. The traditional coronary artery bypass graft procedure is the conventional and effective procedure of cardiac surgery revascularization mode. This study was designed to compare the bypass patency between "one-stop" hybrid coronary revascularization and traditional CABG and PCI in the treatment of coronary artery multi-vessel disease with the aid of mid-term coronary angiography.Methods:In Fuwai Hospital from June2007to December2009,104cases underwent "one-stop" composite coronary revascularization,3540cases underwent conventional CABG,7165cases underwent PCI+drug-eluting stents (DES). The inclusion criteria are:1) combined anterior descending artery (LAD) coronary artery lesions in patients with triple vessel disease;2) The patients are drug well-controlled, had no chest pain, nor re-hospitalization or MACCE during following-up;3) the doctors who performed MIDCAB, the conventional CABG and the PCI+DES procedure are experienced ones (Note:The experienced surgeon is defined as those who have accumulated experiences in CABG surgical treatment for more than5years, with over100cases done each year; the experienced PCI physician as those with over5years’work experience in PCI and over300cases done each year.)Based on the above requirements, we got102Hybrid cases,292CABG cases and356PCI cases into our study. Patients who are contacted on phone and finally agreed to take angiography check are102Hybrid cases,147CABG cases, and157PCI cases, respectively. From October,2010to December,2011, as many as50Hybrid patients signed the agreement and underwent angiography. Among the147CABG cases and157PCI cases,50cases of each are selected for coronary angiography with the use of propensity score1:1matching method. The study focuses on the medium-term target vessel patency rates and secondary blood supply and reconstruction rates. Results:Selected subjects are50for each of the three groups:the Hybrid group the CABG group, and the PCI group, and the follow-up time was18±8.03months,20.3±6.77months,19.3±9.12months (p=0.153), respectively. There is no significant differences in baseline characteristics among the three groups of patients.1Results of coronary angiographyThere were50LIMA bypasses and64non-LAD target vessels in Hybrid group, and the imaging results showed a target vessel patency rate of89.5%(12/114), and a revascularization rate of7.9%(9/114). In CABG group with a total of178coronary artery bypass cases, the overall patency rate is78.7%, and the revascularization rate0. In PCI group, there are50cases of the anterior descending branch target revascularization,54of left anterior descending branch target vessel revascularization. Angiography showed a target vessel patency rate of82.7%, and a revascularization rate of20.4%.2The comparative analysis of coronary angiography results2.1Hybrid Vs CABG:The coronary angiography results showed a significantly higher rate of overall patency enjoyed by Hybrid group over CABG group (89.5%Vs78.7%, p=0.017), and no significant difference in either LIMA-LAD bypass patency (98%Vs89.1%, p=0.17) or the patency of non-left anterior descending branch target vessel (DES)(82.8%Vs75.8%, p=0.267) between the two groups.2.2Hybrid Vs PCI:The coronary angiography results showed no significant difference in overall patency between the Hybrid group and PCI group (89.5%Vs82.7%, p=0.07), a significantly higher patency rate in Hybrid LIMA-LAD bypass group over the PCI LAD target vessel group (98%Vs80%, p=0.004), no significant difference in non-LAD target vessel patency between the two (82.8%Vs85.2%, p=0.727), a significantly lower rate of target vessel revascularization in Hybrid over PCI (12.5%Vs19.2%, p=0.014), and a significantly lower revascularization rate in Hybrid LIMA bypasses over PCI LAD target vessels (2%Vs20%, p=0.008).2.3CABG Vs PCIThe coronary angiography results showed no significant patency difference in CABG LIMA-LAD bypasses and PCI LAD target vessels (89.1%Vs80%, p=0.218), no significant patency difference in non-left anterior descending branch target vessel (DES) between CABG and PCI (75.8%Vs85.2%, p=0.158), and a significantly higher rate of LAD target vessel revascularization in PCI over CABG (20%Vs0, p<0.001). Conclusion:1For the "one-stop" hybrid revascularization treatment of coronary artery multi-vessel disease, its LIMA-LAD bypass patency rate is significantly superior to the DES patency rate of percutaneous coronary intervention technology with LAD, but not significantly different from CABG.2The non-LAD patency of "one-stop" hybrid revascularization group with DES is similar to that of SVG bypass of the conventional CABG;3The patency rate of the traditional CABG surgery is similar to that of PCI, but the second target vessel revascularization rate was significantly higher in PCI than in CABG;... |
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