论著·临床研究

冠状动脉杂交术与非体外冠状动脉旁路移植术在合并前降支狭窄的双支冠状动脉病变中的疗效:倾向性评分匹配对比研究

  • 朱鹏雄 ,
  • 裘佳培 ,
  • 徐洪 ,
  • 谢博涛 ,
  • 刘俊
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  • 上海交通大学医学院附属瑞金医院心脏外科,上海200025
朱鹏雄(1992—),男,博士生;电子信箱:pengxiongzhu@me.com。

网络出版日期: 2018-05-03

Clinical results of HCR compared with OPCABG on two-vessel coronary artery disease with proximal left anterior descending stenosis: a propensity-score-matched follow-up study

  • ZHU Peng-xiong ,
  • QIU Jia-pei ,
  • XU Hong ,
  • XIE Bo-tao ,
  • LIU Jun
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  • Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Online published: 2018-05-03

摘要

目的·利用倾向性评分匹配(propensity score matching,PSM)平衡冠状动脉杂交术(hybrid coronary revascularization,HCR)与非体外冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)的混杂因素,评价二者在处理合并前降支狭窄的双支冠状动脉病变中的疗效。方法·纳入2009年1月—2016年12月在上海交通大学医学院附属瑞金医院行HCR或OPCABG的合并前降支狭窄的双支冠状动脉病变患者,HCR组52例,OPCABG组128例。对2组患者进行PSM得到风险调整后的临床结果,通过Kaplan-Meier曲线分析2组免于主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)与靶血管再次血运重建(target vessel revascularization,TVR)的生存情况。结果·平均随访时间为59个月(13~104个月)。HCR组的住院时间显著低于OPCABG组[(15.3±4.5)d vs(17.6±5.4)d,P0.027],2组患者在其他各项院内短期临床终点上的差异均无统计学意义。在中期随访结果中,2组的MACCE(11.4% vs 13.3%,P0.968)、死亡(2.3% vs 4.4%,P0.984)、心肌梗死(2.3% vs 2.2%,P0.485)、脑卒中(4.5% vs 6.7%,P0.979)及TVR(4.5% vs 2.2%,P0.984)的发生率比较,差异均无统计学意义。2组免于MACCE(P0.906)或免于TVR(P0.541)的生存情况比较,差异亦无统计学意义。结论· HCR处理合并前降支狭窄的双支冠状动脉病变患者具有良好的中期疗效。在处理合并前降支狭窄的双支冠状动脉病变患者时,应该积极考虑HCR作为OPCABG的替代方案。

本文引用格式

朱鹏雄 , 裘佳培 , 徐洪 , 谢博涛 , 刘俊 . 冠状动脉杂交术与非体外冠状动脉旁路移植术在合并前降支狭窄的双支冠状动脉病变中的疗效:倾向性评分匹配对比研究[J]. 上海交通大学学报(医学版), 2018 , 38(4) : 430 . DOI: 10.3969/j.issn.1674-8115.2018.04.014

Abstract

Objective · To explore the difference between hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting(OPCABG) on two-vessel coronary artery disease with proximal left anterior descending stenosis with propensity score matching. Methods · The patients with two-vessel coronary artery disease with proximal left anterior descending stenosis who underwent isolated HCR or OPCABG were selected in Ruijin Hospital January 2009 to December 2016. The propensity score methodology was used to obtain risk-adjusted outcome. Kaplan-Meier analysis was applied to estimation of major adverse cardiac and cerebrovascular events (MACCE)-free survival rate and target vessel revascularization (TVR)-free survival rate. Results · The average follow-up time was 59 months (13–104 months). The length of hospital stay of HCR group was significantly shorter than that of OPCABG group [(15.3±4.5) d vs (17.6±5.4) d, P0.027]. There was no statistical difference in other short-term clinical endpoints in hospital. In midterm, there was no statistical difference in the rate of MACCE (11.4% vs 13.3%, P0.968), death (2.3% vs 4.4%, P0.984), myocardial infarction(2.3% vs 2.2%, P0.485), stroke (4.5% vs 6.7%, P0.979) and TVR (4.5% vs 2.2%, P0.984) between two groups. And there was no statistical difference in MACCE-free survival rate (P0.906) and TVR-free survival rate (P0.541) between two groups. Conclusion · HCR provides favorable midterm outcomes for selected patients with two-vessel coronary artery disease with proximal left anterior descending stenosis. It might provide a promising alternative to OPCABG.
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