A Comparative Study Of One-stop Hybrid Coronary Revascularization With Coronary Artery Bypass Grafting And Percutaneous Coronary Intervention In The Treatment Of Multiple Coronary Artery Lesions

Introduction and Aim:At present,coronary atherosclerotic heart disease has become the leading cause of death in China,and the treatment techniques for coronary atherosclerotic heart disease are changing with each passing day.The treatment methods for revascularization mainly include surgical CABG and internal PCI,and the selection is mainly based on SYNTAX score.However,these two methods have both advantages and disadvantages.Therefore,the optimal revascularization strategy for patients with multiple coronary artery diseases is still a controversial topic.At the end of the 20 th century,a new treatment method was proposed,which perfectly combined the surgical and internal medicine techniques,maintaining the advantages of each operation while avoiding the disadvantages to the greatest extent.This new method is the hybrid coronary revascularization,which means hybrid surgery.From this method until now,has been in the past 20 years,but very few related clinical studies,this study compares the one-stop composite coronary arterial blood transport reconstruction technique(One-stop hybrid coronary revascularization)and percutaneous coronary intervention(PCI)in the treatment of coronary artery vascular lesions in patients with more short-term and medium-term curative effect,discusses the SYNTAX score high-risk patients in the minimally invasive treatment method of optimal revascularization.Objective: To compare the short-term and medium-term effects of one-stop hybrid coronary revascularization with coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)in patients with coronary multi-vessel disease,and to explore the optimal revascularization method for high-risk patients in SYNTAX score.Methods: From January 2014 to October 2017,52 patients with multiple coronary artery lesions underwent one-stop hybrid coronary revascularization in the First Affiliated Hospital of Anhui Medical University.During the same period,1035 patients with multiple coronary artery lesions underwent PCI,854 patients underwent GABG.Propensity score was used to match 52 patients in PCI group and CABG group with one-stop coronary revascularization group.They were divided into three groups: CHR group,CABG group and PCI group.The end point of the study was to avoid major adverse cardiac and cerebrovascular events(MACCE)during the follow-up period,including all-cause mortality,myocardial infarction,cerebrovascular accidents and target vascular reestablishment rate.At the same time,the related conditions of patients during hospitalization were compared,including hospitalization time,time in intensive care unit,perioperative complications and so on.Results: There was no statistical difference in the main clinical data of the three groups,and there was no statistical difference in the coronary anatomical score(SYNTAX)of the three groups.There was no significant difference in the number of stent implantation and the length of stent between the HCR group and the PCI group.All the patients in the three groups had successful surgery and no death.The total hospitalization time of the HCR group was longer than that of the PCI group,but shorter than that of the CABG group.After an average of 27 months follow-up,the total incidence of MACCE no significant difference between the three groups(P = 0.074),but the HCR group compared with PCI group,the total incidence of MACCE reduced significantly(P = 0.028),HCR and CABG group goals target vascular remodeling rate is lower than the PCI group(P = 0.016),and in death,myocardial infarction,cerebrovascular accident,gastrointestinal bleeding,recurrence of angina pectoris were no obvious difference.SYNTAX score and Euro Score were compared for risk stratification among the three groups of patients,the higher of SYNTAX score and Euro Score,the lower of MACCE incidence in HCR(P=0.002,P=0.030).Conclusion: 1.Among high-risk patients in SYNTAX score,one-stop hybrid coronary revascularization is superior to conventional CABG and PCI in mid-term clinical effect,not inferior to CABG,the higher of SYNTAX score and Euro Score,the lower of MACCE incidence in HCR.2.There was no increase in perioperative complications during one-stop hybrid coronary revascularization.