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Hybrid coronary revascularization may be efficacious in older patients
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Hybrid coronary revascularization yielded fewer procedural complications and comparable mortality when compared with CABG in a cohort of individuals aged at least 65 years.
Ralf E. Harskamp, MD, with the University of Amsterdam, the Netherlands, and Duke Clinical Research Institute, Durham, N.C., and fellow study researchers described hybrid coronary revascularization as a combination of “minimally invasive left internal mammary artery-to-left anterior descending coronary artery grafting with [PCI] of non-left anterior descending coronary arteries.”
In the current analysis, Harskamp and colleagues aimed to determine whether this approach is safe and effective in an elderly population. Eligible participants underwent the procedure at a single academic center from October 2003 to September 2013.
Ralf E. Harskamp
A cohort of patients who underwent the hybrid strategy was matched in a 1:4 ratio to similar patients who underwent CABG. There were 143 patients in the combination group and 572 in the CABG group. The researchers conducted a propensity-score matched algorithm to compare the two groups.
MACCE at 30 days served as the primary outcome, along with periprocedural complications and 3-year all-cause death.
The hybrid approach was associated with a 5.6% MACCE rate compared with 3.8% for CABG (OR=1.46; 95% CI, 0.65-3.27; P=.36).
There were fewer procedural complications with hybrid coronary revascularization than CABG (9.1% vs. 18.2%; P=.018). The hybrid approach also yielded lower rates of blood transfusions (28% vs. 53.3%; P<.0001), chest tube drainage (838 ± 484 vs. 1,100 ± 579 cm3; P<.001) and shorter lengths of stay (<5 days, 45.5% vs. 27.4%; P=.001).
Mortality during 3 years of follow-up was 13.2% for hybrid coronary revascularization and 16.6% for CABG (HR=0.81; 95% CI, 0.46-1.43; P=.47).
The researchers also conducted a subgroup analysis in patients with a Charlson index ≥6 and aged ≥75 years, which they deemed to be at high risk. Similar outcomes were reported in this subgroup.
“Although the present data are limited, we found that in older patients, the use of [hybrid coronary revascularization] is safe, has fewer procedural complications, entails less blood product use, and results in faster recovery with similar longitudinal outcomes relative to conventional CABG,” Harskamp and colleagues concluded.
Disclosure: The researchers report financial disclosures with Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Genentech, Intuitive Surgical, Janssen Pharmaceutical Products, Medtronic, Merck, Sanofi Aventis and Somahlution.
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