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Hybrid coronary revascularization, CABG yield similar mortality rates
All-cause mortality rates were similar between hybrid coronary revascularization and conventional CABG, according to the results of a 5-year follow-up of the HYBRID trial, recently published in JACC: Cardiovascular Interventions.
“Conventional CABG is still an evidence-based gold standard in the treatment of patients with multivessel CAD,” Mateusz Tajstra, MD, from the department of cardiology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland, and colleagues wrote in the study background. “There is a lack of robust clinical data, and available data are mostly limited to observational studies with short-term follow-up. Accordingly, the aim of this study was to evaluate the 5-year clinical outcome for the patient population from the HYBRID study.”
The researchers randomly assigned 200 patients with multivessel CAD referred for conventional surgical revascularization to undergo hybrid coronary revascularization or CABG and defined the occurrence of all-cause mortality at 5 years as the primary endpoint.
During follow-up, nine patients (n = 4 in the hybrid group) were lost, leaving 191 patients (n = 94 in the hybrid group) for the basis of the study.
At 5 years, the researchers observed similar all-cause mortality rates in both groups (6.4% for hybrid vs. 9.2% for CABG; P = .69).
They also found that MI (4.3% vs. 7.2%; P = .3), repeat revascularization (37.2% vs. 45.4%; P = .38), stroke (2.1% vs. 4.1%; P = .35), and MACCE (45.2% vs. 53.4%; P = .39) rates were also similar for the hybrid approach and CABG, respectively.
The researchers recommended broader implementation of hybrid coronary revascularization in daily practice after validation in multicenter, adequately powered randomized studies.
An accompanying editorial from Adrian W. Messerli, MD, and Noaki Misumida, MD, both from the Gill Heart Institute and division of cardiovascular medicine at the University of Kentucky, suggested that the results remain small and mostly hypothesis-generating.
“To be fair, all available data suggest [hybrid coronary revascularization] is feasible and safe in skilled hands, with 1- and 5-year outcomes noninferior to conventional CABG in low- to intermediate-risk patients with multivessel CAD. But the utilization of [hybrid coronary revascularization] remains low, in part due to a number of clinical unknowns, but also due to practical limitations,” they wrote. “Until [hybrid coronary revascularization] can prove superiority to conventional CABG in clinical outcomes such as significant morbidity or stroke reduction, adoption of this strategy will likely continue to be modest.” – by Dave Quaile
Disclosures: Messerli, Misumida and Tajstra report no relevant financial disclosures. Another author reports he consults for Abbott, Atricure and Symetis/Boston Scientific.