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MACCE rates similar for multivessel PCI, hybrid coronary revascularization
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Patients treated with multivessel PCI or hybrid coronary revascularization displayed no significant difference in MACCE rates over 12 months, according to a study published in the Journal of the American College of Cardiology.
In hybrid coronary revascularization, an operator performs minimally invasive CABG of the left anterior descending artery and PCI of the other anterior descending vessels, according to the study background.
“[The researchers] show that [hybrid coronary revascularization] of multivessel revascularization is not inferior to multivessel PCI, and that better long-term sustainability could be achieved over time,” Anno Diegeler, MD, PhD, from Herz-und Gefässklinik Bad Neustadt, Halle, Germany, wrote in a related editorial.
During an 18-month period, 200 patients undergoing hybrid coronary revascularization and 98 undergoing multivessel PCI were enrolled at 11 centers in the United States. The mean age of the patients was 64 years, and 25% of patients were female. Thirty-eight percent had three-vessel CAD, 38.6% had diabetes, 4.7% had previous stroke and the mean SYNTAX score was 19.7.
The primary outcome was MACCE, defined as death, stroke, MI or repeat revascularization, at 12 months.
“There was significant heterogeneity in management of patients with hybrid-eligible coronary anatomy across the 11 experienced study sites,” the researchers wrote. “This demonstrates the absence of consensus among experienced [hybrid coronary revascularization] and PCI operators due to lack of evidence regarding the relative effectiveness of these two alternative revascularization strategies.”
MACCE rates were similar between groups at 12 months (HR = 1.063, P = .8) and at a median 17.6 months of follow-up (HR = 0.868, P = .53), when adjusted for baseline risk.
“It is always appealing to look for less-invasive treatment strategies,” Diegeler wrote. “In cardiac diseases, we increasingly tend to offer shortsighted treatment, and only a few people ask what will come further down the road.”
While acknowledging that a randomized trial is needed, the researchers wrote, “[Hybrid coronary revascularization] seeks to optimize outcomes of revascularization by combining the most beneficial attributes of surgical coronary revascularization and [PCI].” – by James Clark
Disclosure: Some researchers report financial ties with AstraZeneca, Intuitive Surgical and Medtronic. Diegeler reports no relevant financial disclosures.
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