ハイブリッド冠動脈血行再建術 vs. 高リスク多枝冠動脈疾患におけるPCI：2施設、2年間の予後比較

Treatment strategies for multivessel coronary artery disease (MV-CAD) include percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and the increasingly adopted hybrid coronary revascularization (HCR). HCR combines minimally invasive left internal mammary artery (LIMA)-to-left anterior descending (LAD) grafting with PCI of non-LAD lesions. However, comparative evidence in high-risk MV-CAD remains limited.

We retrospectively analyzed 330 high-risk MV-CAD patients from two centers (HCR n = 109; PCI n = 221) over 2 years. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: all-cause death, stroke, myocardial infarction, repeat revascularization, and angina). Kaplan-Meier survival analysis and conventional statistical tests were applied.

Baseline demographics and SYNTAX scores were similar between groups. HCR involved fewer and shorter stents than PCI. Hospital stay, ICU duration, and total costs were higher with HCR. At 2 years, angina (5.5% vs. 17.2%; P = 0.003) and MACCE (12.8% vs. 23.5%; P = 0.02) were lower with HCR; overall survival by Kaplan-Meier favored HCR (log-rank P = 0.0006).

Despite longer hospitalization and higher costs, HCR was associated with superior long-term symptom relief and lower MACCE compared with PCI in high-risk MV-CAD. These findings support HCR as a viable strategy in carefully selected patients and warrant validation in prospective multicenter studies.