Hybrid revascularization, comprising coronary artery bypass graft with exclusive arterial conduits followed by early drug-eluting stent implantation, in multivessel coronary artery disease

Autor: Thomas Modine, Christophe Bauters, C. Delhaye, Gilles Lemesle, Jean-Marc Lablanche, Mohamad Koussa, Georges Fayad, Laure Vanesson, Arnaud Sudre
Rok vydání: 2010
Předmět:
Male
Time Factors
medicine.medical_treatment
Coronary Artery Bypass
Off-Pump
Myocardial Infarction
Coronary Artery Disease
Coronary artery disease
Risk Factors
Myocardial infarction
Prospective Studies
Angioplasty
Balloon
Coronary
Coronary Artery Bypass
Revascularization hybride
Stent actif
Drug-Eluting Stents
General Medicine
Middle Aged
Clopidogrel
Combined Modality Therapy
surgical procedures
operative
Treatment Outcome
Drug-eluting stent
Cardiology
Platelet aggregation inhibitor
Female
France
Coronary bypass
Cardiology and Cardiovascular Medicine
TIMI
medicine.drug
medicine.medical_specialty
Ticlopidine
Revascularization
Risk Assessment
Internal medicine
medicine
Humans
cardiovascular diseases
Hybrid revascularization
Aged
Chi-Square Distribution
Aspirin
business.industry
Stent
Pontage coronaire
medicine.disease
Surgery
Case-Control Studies
Feasibility Studies
business
Platelet Aggregation Inhibitors
Zdroj: Archives of Cardiovascular Diseases. 103(10):502-511
ISSN: 1875-2136
DOI: 10.1016/j.acvd.2010.09.003
Popis: Summary Aim To assess the feasibility and safety of a hybrid myocardial revascularization strategy combining “exclusive arterial” conventional coronary artery bypass grafting (CABG) followed by early drug-eluting stent (DES) implantation in multivessel coronary artery disease (CAD). Methods Eighteen consecutive patients with multivessel CAD were enrolled prospectively. Within 48 hours of CABG using left internal mammary artery (IMA) to left anterior descending (LAD) coronary artery with or without right IMA to non-LAD vessel in an open chest approach, DESs were implanted systematically in an additional vessel after a clopidogrel 300-mg preloading dose. This group was compared with 18 matched patients who underwent standard CABG alone using left IMA to LAD and at least one additional graft. Results Baseline clinical characteristics were similar in both groups. There were 46 grafts in the CABG group and 28 in the hybrid group. In the hybrid group, 27.8% of patients were treated off-pump versus none in the CABG group; a median of 2 (interquartile range: 1–2) stents was implanted per patient. The hybrid procedure was associated with shorter durations of cardiopulmonary bypass (77 [67–100] min versus 97 [90–105] min, P = 0.049). Major bleeding rates were higher in the CABG group, but the difference was not statistically significant (44.4% versus 11.1%, P = 0.06). Re-intervention for bleeding was not needed in either group. One (5.6%) myocardial infarction occurred in hospital in each group following CABG. At 1 year, the cumulative rates of major adverse cardiac events (death, myocardial infarction, target vessel revascularization) were similar (11.2% in hybrid group versus 5.6% in CABG group, P = 0.99). One death occurred in the CABG group and one target vessel revascularization in the hybrid group. Conclusion A hybrid revascularization strategy, combining conventional CABG with exclusive arterial conduits followed by early DES implantation, is feasible. One-year event rates compare favourably to those with traditional CABG alone.
Databáze: OpenAIRE
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