Original title: Hybrid Revascularization for Multivessel Coronary Artery Disease Reference: Mariuz Gassior, et al. J Am Cardiol Intv 2014;7:1277-83

According to the international guidelines, coronary artery bypass grafting (CABG) continues to be the “Gold Standard” treatment for multiple vessels diseases. However, second generation DES and the hybrid strategy may eventually change indications.  

This study randomized 102 patients undergoing CABG and 98 undergoing hybrid coronary revascularization (HCR). Hybrid revascularization consisted of the placement of a mammary artery onto the left anterior descending coronary artery and PCI with everolimus-eluting DES (Xience) to RC and/or CX.

Primary end point was feasibility of HCR, death, infarction, stroke, repeat revascularization and major bleeding at 12 months. 

Demographic, clinical and angiographic characteristics were well balanced in both groups with the exception of BMI that resulted lower in the HCR group. More than half of patients presented three vessels lesions, an average of four, and 23 SYNTAX score. 

78% of the population had complete revascularization. The hybrid group received 2.3 stents/patient and surgery to PCI time was 21 horas. The CABG group received 2.7 conduits/patient, 24% had complete arterial revascularization and 85% was done off-pump. There were no differences in hospitalization time.

At 12 months, there were no differences in primary end point (10.2% for the hybrid group and 7.8% for the CABG group; p=0.54). HCR was feasible in 94%.

80% of patients were followed up with angiography, and graft patency was 94% in the HCR group vs. 93% in the CABG group. In-stent restenosis was 7.5% and graft patency, but for the mammary artery, was 79%. 

Conclusion

These outcomes show HCR is feasible in selected patients with multivessel disease.

 Commentary

This is the first randomized study to show the feasibility of HCR, with similar results to CABG in intermediate risk patients.

Multiple vessels patient population is aging and increasing in comorbidity, which makes this strategy effectively valid since it is less invasive and required less surgical time.

In addition, outcomes can be improved with the use of FFR and imaging methods, and this strategy may also be used in treating valvulopathy.

Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires – Argentina 

Carlos Fava