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Hybrid revascularization shows favorable midterm results in multivessel disease
Hybrid coronary revascularization with PCI and CABG resulted in positive outcomes at 3 years among patients with multivessel disease in a single center study published in the Journal of the American College of Cardiology.
The authors of the study set out to examine the utility of hybrid coronary revascularization (HCR) in patients with left anterior descending chronic total occlusion, excessive tortuosity, severely diffuse lesions and unprotected left main artery disease. They enrolled 141 consecutive patients with multivessel CAD at the Fuwai Hospital in Beijing, China, and matched them with two separate groups of 141 patients who underwent isolated PCI or CABG. All patients were stratified by EuroSCORE and SYNTAX score.
For the HCR group, investigators performed one-stop HCR, which consisted of PCI, CABG and an antiplatelet therapy regimen. The hybrid heart team performing HCR was comprised of two interventional cardiologists and two surgeons.
At follow-up (mean, 3 years), the rate of MACCE, the study’s primary endpoint, was 6.4% in the hybrid group, which was significantly lower than the PCI group (22.7%; P<.001), but similar to CABG-treated patients (13.5%; P=.140). Survival was 99.3% in the HCR group, 97.2% in the CABG group and 96.5% in the PCI group (log rank P=.344).
In all, six patients in the HCR group underwent repeat revascularization compared with three patients in the CABG group and 18 patients in the PCI group.
The researchers wrote that HCR is ideal in patients in whom technical or anatomic limitations to CABG or PCI alone may be present and for whom minimizing the invasiveness — and therefore the risk of morbidity and mortality — of surgical intervention is preferred.
“Patients selection based on heart team approach is the key point whether HCR strategy could offer favorable outcomes for patients with multivessel disease,” they wrote.
Disclosure: Shen reports no relevant financial disclosures.
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