| Objectives:The purpose of this study was to evaluate the safety and efficiency of one-stop hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (CAD).Methods:From June 2007 to September 2014,410 consecutive patients with multivessel CAD who underwent one-stop HCR and 9111 consecutive patients with multivessel CAD who underwent isolated off-pump coronary artery bypass (OPCAB) at Fuwai Hospital were included. Using propensity score matching,410 patients (at least 6 months after operation),360 patients (at least 1 year after operation), and 120 patients with diabetes mellitus (DM) (at least 6 months after operation) who underwent one-stop HCR were respectively matched with those who underwent isolated OPCAB during the same time. There were three samples of one-stop HCR versus OPCAB:410 vs 410,360 vs 360,120 vs 240. The primary endpoint was 30 days or midterm major adverse cardiac or cerebrovascular events (MACCE), and the second endpoints were postoperative inhospital outcomes. Accounting for matched-pairs design, the rates of MACCE and its component events were statistically compared with logistic regression model using generalized estimating equation (GEE), the survival analysis of midterm follow-up was statistically evaluated with marginal Cox regression model; the continuous and the dichotomous variables of the inhospital outcomes were statistically compared with Wilcoxon signed rank test and logistic regression model using GEE respectively.Results:Compared with OPCAB, one-stop HCR had less chest tube drainage (mL) (740 [520,1040] vs 970 [730,1320], P<0.0001), lower reoperation for controlling bleeding rates (0.5% vs 2.4%, P=0.0373), no significantly lower transfusion rates (25.1% vs 31.2%, P=0.0633), and shorter postoperative mechanical ventilation time (hours) (13.0 [10.3,16.4] vs 16.0 [13.0,19.0], P<0.0001) and stay in intensive care unit (hours) (21.7 [19.8,43.0] vs 41.0 [23.6,69], P<0.0001); over 30 days after operation, one-stop HCR had similar MACCE rates (0.5% vs 1.2%, P=0.4322), similar all-cause mortality (0.5% vs 0%, P=0.1609), similar myocardial infarction (MI) rates (0% vs 0.3%, P=0.4951), and no significantly lower stroke rates (0% vs 1.00%, P=0.0596) compared with OPCAB; and no repeated coronary revascularization incidents were observed in both groups. During a midterm of follow-up (months) (33.7 [18.6,56.1] vs 32.3 [17.8,43.4], P=0.2362), one-stop HCR had similar MACCE rates (8.3% vs 8.1%, P=0.8877; HR:1.016,95% CI [0.607,1.701], P=0.9512), similar all-cause mortality (2.5% vs 2.9%, P=0.7601; HR:0.858,95% CI [0.330,2.230], P=0.7535), similar myocardial infarction (MI) rates (0.3% vs 0.9%, P=0.3262; HR: 0.316,95% CI [0.034,2.957], P=0.3119), lower stroke rates (0.6% vs 2.9%, P=0.0330; HR:0.179,95% CI [0.040,0.796], P=0.0238), higher repeated coronary revascularization rates (5.3% vs 2.3%, P=0.0395; HR:2.281,95% CI [1.031,5.046], P=0.0417), however, similar target lesion repeated revascularization (2.5% vs 2.0%, P=0.6397; HR:1.211,95% CI [0.488, 3.006], P=0.6797) compared with OPCAB. In patients with DM, there were similar perioperative outcomes with all patients except lower packed red blood cells transfusion rates (18.3% vs 29.6%, P=0.0324) in one-stop HCR vs OPCAB, and similar midterm outcomes with all patients except similar repeated coronary revascularization rates (4.2% vs 2.5%, P=0.4120; HR: 1.545,95% CI [0.452-5.286], P=0.4881) in one-stop HCR vs OPCAB.Conclusions:For patients with multivessel CAD, and patients complicated with DM, one-stop HCR is a safe and efficient coronary revascularization. Compared with OPCAB, one-stop HCR has less blood loss, decreased transfusion rates, faster recovery, and similar MACCE rates during the perioperative period; and has similar MACCE rates, all-cause mortality and MI rates, lower stroke rates, increased repeated coronary revascularization rates, however, similar target lesion repeated revascularization over a midterm of follow-up. |
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