Long-Term Evolution of Hybrid Coronary Revascularization

Currently, myocardial revascularization surgery (MRS) and percutaneous coronary intervention (PCI) are the available strategies for multivessel coronary artery disease. However, an alternative strategy has long been developed, called hybrid coronary revascularization (HCR), where the anterior descending artery is bypassed with a graft from the mammary artery and the rest of the lesions are treated by PCI.

Evolución a largo plazo de la estrategia de revascularización coronaria híbrida

Different analyses and some randomized studies have been performed using this strategy, all of them with small cohorts and a short follow-up of under 5 years.

An analysis was conducted with patients treated from 2007 to 2018. In total, 70,205 coronary revascularizations were recorded, of which 585 corresponded to patients who received simultaneous HCR (0.83%), 15,118 corresponded to off-pump coronary artery bypass grafting (OP CAB) (21.53%), and 54,502 were cases of PCI (77.63%).

Populations were different, so they were propensity score matched, leaving 540 patients in each group.

Mean patient age was 61 years old, and 80% of subjects were male. Sixty percent of patients had hypertension, 30% had diabetes, 2% had COPD, 0.4% had impaired renal function, 12% had peripheral vascular disease, and 1.7% had atrial fibrillation; 14% had experienced a stroke, 23%, an infarction, and 5.2% had undergone previous PCI.

Ejection fraction was preserved; 38% of patients had LMCA lesions, 62% had 3-vessel lesions, and 26% had 2-vessel lesions.

Read also: Left Main Coronary Artery PCI Using State-of-the-Art Zotarolimus-Eluting Stents.

The Society of Thoracic Surgeons (SYNTAX) mortality score was 28 and the EuroSCORE II was 1.2%.

The stents used were DES of different generations, although some patients received drug-free stents.

The number of vessels revascularized with HCR was lower than with OP CAB (2.1 ± 0.4 vs. 2.5 ± 0.7; p < 0.001), but higher than with PCI (2.1 ± 0.4 vs. 1.4 ± 0.6; p < 0.001).

Residual SYNTAX was higher with HCR than with OP CAB (11.1 ± 6.1 vs. 6.9 ± 7.2; p < 0.001), but lower than with PCI (11.1 ± 6.1 vs. 13.1 ± 7.9; p < 0.001).

Read also: Hybrid Coronary Revascularization: A Valid Option?

The 10-year cumulative major adverse cardiovascular and cerebrovascular events (MACCE) in HCR was similar to OP CAB (28.7% vs. 23.9%; p = 0.15), but significantly lower than for PCI (28.7% vs. 45.3%; p < 0.001). Quality of life was superior in those who underwent HCR and OP CAB compared with those who underwent PCI. 

At follow-up, cardiac mortality, all-cause mortality, infarction, and stroke were similar in the 3 groups.

Hospitalizations and reinterventions were higher for those who underwent HCR compared with OP CAB, but lower than in the PCI group.

Patients with low or intermediate EuroSCORE HCR and OP CAB had similar MACCE rates, which were lower than those for patients in the PCI group. In patients with a high EuroSCORE who underwent HCR, the rates for MACCE were lower compared with patients who received the other two strategies.

Read also: Intervention in Patients with Takayasu Arteritis: Rescue Therapy or an Alternative Complementary to Immunosuppressive Therapy?

In those with SYNTAX Score, there was no difference in MACCE, but in the intermediate and high segment the hybrid strategy was similar to OP CAB, though significantly lower than for those who underwent PCI. 

Conclusion

Compared with conventional strategies, HCR showed satisfactory evolution during a long-term follow-up in MACCE and in quality of life in multivessel coronary artery disease.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Simultaneous Hybrid Coronary Revascularization vs Conventional Strategies for Multivessel Coronary Artery Disease A 10-Year Follow-Up.

Reference: Tong Ding, et al. J Am Coll Cardiol Intv 2023;16:50–60. 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...