Abstract：
Multivessel coronary artery disease is present in ∼50% of patients with acute coronary syndrome and, compared with single-vessel disease, entails a higher risk of new ischaemic events and a worse prognosis. Randomized controlled trials have shown the superiority of \'complete revascularization\' over culprit lesion-only treatment. Trials, however, only included patients treated with percutaneous coronary intervention (PCI), and evidence regarding complete revascularization with coronary artery bypass graft (CABG) surgery after culprit lesion-only PCI (\'hybrid revascularization\') is lacking. The CABG after PCI is an open, non-negligible therapeutic option, for patients with non-culprit left main and/or left anterior descending coronary artery disease where evidence in chronic coronary syndrome patients points in several cases to a preference of CABG over PCI. This valuable but poorly studied \'PCI first-CABG later\' option presents, however, relevant challenges, mostly in the need of interrupting post-stenting dual antiplatelet therapy (DAPT) for surgery to prevent excess bleeding. Depending on patients\' clinical characteristics and coronary anatomical features, either deferring surgery after a safe interruption of DAPT or bridging DAPT interruption with intravenous short-acting antithrombotic agents appears to be a suitable option. Off-pump minimally invasive surgical revascularization, associated with less operative bleeding than open-chest surgery, may be an adjunctive strategy when revascularization cannot be safely deferred and DAPT is not interrupted. Here, the rationale, patient selection, optimal timing, and adjunctive strategies are reviewed for an ideal approach to hybrid revascularization in post-acute coronary syndrome patients to support physicians\' choices in a case-by-case patient-tailored approach.
摘要：
50%的急性冠状动脉综合征患者存在多支冠状动脉疾病，与单支血管疾病相比，新的缺血事件发生的风险较高,预后较差.随机对照试验表明，“完全血运重建”优于罪犯仅病变治疗。试验,然而,仅包括接受经皮冠状动脉介入治疗（PCI）的患者，并且缺乏有关罪犯仅病变PCI（“混合血运重建”）后冠状动脉旁路移植术（CABG）手术的完全血运重建的证据。PCI后的CABG是开放的，不可忽视的治疗选择，对于非罪犯左主干和/或左前降支冠状动脉疾病患者,慢性冠状动脉综合征患者的证据表明,在一些病例中,CABG优于PCI.这个有价值但研究不足的“先PCI-后CABG”选项提出，然而,相关挑战,主要是需要中断支架置入术后双重抗血小板治疗（DAPT），以防止出血过多。根据患者的临床特征和冠状动脉解剖特征，在安全中断DAPT后推迟手术,或者用静脉短效抗血栓药桥接DAPT中断似乎是一个合适的选择.非体外循环微创外科血运重建,与开胸手术相比，手术出血较少，当不能安全地推迟血运重建和DAPT不中断时，可能是一种辅助策略。这里,理由，患者选择,最佳时机，我们回顾了急性冠脉综合征后患者混合血管重建术的理想方法的辅助策略,以支持医师根据患者的具体情况选择。
