Zhizhao Song1, Liuzhong Shen1, Zhe Zheng1, Bo Xu2, Hui Xiong1, Lihuan Li3, Shengshou Hu4. 1. Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 2. Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 3. Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 4. Department of Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: Shengshouhu@yahoo.com.
Abstract
OBJECTIVES: To compare in-hospital and midterm outcomes after one-stop hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) in patients with diabetes mellitus (DM). METHODS: The series included 120 patients with DM who underwent one-stop HCR at Fuwai Hospital between June 2007 and September 2014. These patients were 1:2 matched with 240 patients who underwent OPCAB using propensity score matching. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and secondary endpoints were in-hospital outcomes. Accounting for matched-pairs design, the survival analysis was evaluated with a marginal Cox model, and the continuous and dichotomous variables of in-hospital outcomes were compared with the Wilcoxon signed-rank test and a logistic regression model using generalized estimating equations, respectively. RESULTS: Compared with OPCAB, one-stop HCR was associated with less chest tube drainage (median, 748 mL [interquartile range (IQR), 540-1080 mL] vs 990 mL [IQR, 730-1250 mL]; P < .001), a lower packed red blood cell transfusion rate (18.3% vs 29.6%; P = .032), shorter mechanical ventilation time (median, 13.7 hours [IQR, 10.3-16.9 hours] vs 16.8 hours [IQR, 13.0-19.6 hours]; P < .001), and shorter stay in intensive care unit (median 21.7 hours [IQR, 19.0-44.3 hours] vs 46.7 hours [IQR, 24.3-72.7 hours]; P < .001). Over 30 months of follow-up, one-stop HCR and OPCAB had a similar rate of MACCE (7.4% vs 8.0% at 3 years; hazard ratio, 0.807; 95% confidence limit, 0.352-1.849; P = .612), but one-stop HCR had a lower stroke rate (0% vs 3.6% at 3 years; P = .046). CONCLUSIONS: For selected patients with DM, one-stop HCR provided safe and reproducible revascularization, with less perioperative invasiveness and similar and favorable midterm outcomes compared with OPCAB.
OBJECTIVES: To compare in-hospital and midterm outcomes after one-stop hybrid coronary revascularization (HCR) and off-pump coronary artery bypass (OPCAB) in patients with diabetes mellitus (DM). METHODS: The series included 120 patients with DM who underwent one-stop HCR at Fuwai Hospital between June 2007 and September 2014. These patients were 1:2 matched with 240 patients who underwent OPCAB using propensity score matching. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and secondary endpoints were in-hospital outcomes. Accounting for matched-pairs design, the survival analysis was evaluated with a marginal Cox model, and the continuous and dichotomous variables of in-hospital outcomes were compared with the Wilcoxon signed-rank test and a logistic regression model using generalized estimating equations, respectively. RESULTS: Compared with OPCAB, one-stop HCR was associated with less chest tube drainage (median, 748 mL [interquartile range (IQR), 540-1080 mL] vs 990 mL [IQR, 730-1250 mL]; P < .001), a lower packed red blood cell transfusion rate (18.3% vs 29.6%; P = .032), shorter mechanical ventilation time (median, 13.7 hours [IQR, 10.3-16.9 hours] vs 16.8 hours [IQR, 13.0-19.6 hours]; P < .001), and shorter stay in intensive care unit (median 21.7 hours [IQR, 19.0-44.3 hours] vs 46.7 hours [IQR, 24.3-72.7 hours]; P < .001). Over 30 months of follow-up, one-stop HCR and OPCAB had a similar rate of MACCE (7.4% vs 8.0% at 3 years; hazard ratio, 0.807; 95% confidence limit, 0.352-1.849; P = .612), but one-stop HCR had a lower stroke rate (0% vs 3.6% at 3 years; P = .046). CONCLUSIONS: For selected patients with DM, one-stop HCR provided safe and reproducible revascularization, with less perioperative invasiveness and similar and favorable midterm outcomes compared with OPCAB.
Authors: Karel M Van Praet; Markus Kofler; Timo Z Nazari Shafti; Alaa Abd El Al; Antonia van Kampen; Andrea Amabile; Gianluca Torregrossa; Jörg Kempfert; Volkmar Falk; Husam H Balkhy; Stephan Jacobs Journal: Interv Cardiol Date: 2021-05-19