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HREVS: 3 procedures for multivessel CAD result in similar outcomes

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Roman Tarasov

The rates of residual myocardial ischemia and MACCE were similar in patients with multivessel CAD who underwent PCI, CABG or hybrid revascularization, according to data presented at TCT 2017.

Roman Tarasov, MD, PhD, head of the laboratory of reconstructive surgery at the State Research Institute for Complex Issues of Cardiovascular Diseases in Kemerovo, Russia, and colleagues analyzed Hybrid Coronary Revascularization Versus Standards (HREVS) trial data from 155 patients with multivessel CAD who were assigned to undergo CABG (n = 50; mean age, 61 years; 70% men), PCI (n = 53; mean age, 62 years; 70% men) or hybrid revascularization (n = 52; mean age, 62 years; 75% men). Patients who previously underwent CABG or PCI, had left main coronary artery stenosis or chronic total occlusions were excluded from the study.

The primary endpoint was residual myocardial ischemia at 12 months determined by single-photon emission CT. Secondary endpoints included MACCE, which were defined as MI, stroke, death or clinically driven target vessel revascularization, and target vessel or graft failure.

“Residual ischemia is not only an index of revascularization quality, but also an important and validated prognostic index,” Tarasov said.

At 30 days, 9.6% of patients in the hybrid revascularization group converted to CABG (P = .027). There was a high rate of bleeding in the CABG group (P = .001).

Patients who underwent PCI had shorter hospital stays (4.5 days) vs. those who underwent CABG (13.8 days) and hybrid revascularization (13.5 days) at 30 days. Sick leave was 8 weeks for PCI, 16 weeks for hybrid revascularization and 23 weeks for CABG (P < .001).

At 12 months, the incidence of residual myocardial ischemia, target vessel or graft failure, and MACCE did not differ among the three groups.

MACCE-free survival at 12 months was 88% for the CABG group, 86.6% in the hybrid revascularization group and 86.8% in the PCI group.

“Shorter hospitalization and quicker recovery with multivessel coronary PCI may provide health care system benefits,” Tarasov said during a press conference. – by Darlene Dobkowski

Reference:

Ganyukov V, et al. First Report Investigations 1. Presented at: TCT Scientific Symposium; Oct. 29-Nov. 2, 2017; Denver.

Disclosure: Tarasov reports no relevant financial disclosures.