Clinical Application Of One - Stop Compound Revascularization In The Treatment Of Multiple Coronary Artery Disease

Objectives This study sought to compare middle and long term clinical outcomes of one-stop hybrid coronary revascularization with coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease, and discuss the optimal indication for one-stop hybrid coronary revascularization. Also, we compared the inhospital and midterm outcomes after one-stop hybrid coronary revascularization with off-pump coronary artery bypass (OPCAB) in patients with diabetes mellitus (DM).Methods From June 2007 to December 2010,141 consecutive patients underwent one-stop hybrid revascularization at Fuwai Hospital. During the same period,5797 patients underwent isolated CABG through median sternotomy, and 4254 patients underwent PCI. Using propensity score methodology, these patients were matched with two separate groups of 141 patients who underwent isolated CABG or PCI during the same period. All patients were stratified by the European System for Cardiac Operative Risk Evaluation Score (Euroscore) and the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score (Syntax score) respectively. 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) rate in each risk tertile were compared.120 patients with DM were included who underwent one-stop HCR at Fuwai Hospital from June 2007 to September 2014. These patients were 1:2 matched with those who underwent OPCAB using propensity score matching. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE) over midterm follow-up, and the second endpoints were inhospital outcomes.Results At a mean follow-up of 4.5years, one-stop hybrid revascularization incurred lower MACCE rate than PCI (P<0.001), but similar with CABG (P=0.150). After stratification by Euroscore or Syntax score respectively, the cumulative MACCE rate was similar among three groups in low and medium tertiles. But in high Euroscore tertile, patients who underwent one-stop HCR had lower MACCE rate than CABG (P=0.017) and PCI (P<0.001). Meanwhile, patients with high Syntax score who underwent one-stop HCR had lower MACCE rate than PCI (P<0.001), but similar rate with CABG (P=0.355).One-stop HCR had less chest tube drainage (748ml [540,1080] vs 990 [730, 1250], P<0.001), lower packed red blood cells (PRBC) transfusion rate (18.3% vs 29.6%, P=0.032), shorter mechanical ventilation time(13.7 hours [10.3, 16.9] vs 16.8 [13.0,19.6], P<0.001), and shorter stay in intensive care unit (21.7 hours[19.0,44.3] vs 46.7 [24.3,72.7], P<0.001) than OPCAB. Over 30 months follow-up, one-stop HCR had similar MACCE rate (6.7% vs 8.0%, P=0.612), but lower stroke rate (0% vs 3.4%, P=0.046) compared with OPCAB.Conclusions One-stop hybrid revascularization provides favorable mid and long term outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with conventional high risk factors, it might provide a promising alternative to CABG and PCI. For selected patients with DM, one-stop HCR provided a safe and reproduciblerevascularization in that it decreased perioperative invasiveness and incurred similar and favorable midterm outcomes compared with OPCAB.