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Hybrid coronary revascularization in 100 patients with multivessel coronary disease
Alberto Repossini1, Maurizio Tespili2, Antonio Saino2
1University of Brescia, Medical School, Brescia, Italy.
Insights
Hybrid coronary revascularization offers a minimally invasive approach for complete revascularization. This study found it a viable option, particularly for high-risk patients, with good long-term outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) combines left internal mammary artery (LIMA) grafting to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) on non-LAD vessels.
- HCR is an alternative to conventional coronary artery bypass grafting (CABG) and multivessel PCI for achieving complete revascularization.
Purpose of the Study:
- To evaluate the long-term outcomes of hybrid coronary revascularization.
- To assess the rates of major adverse cardiac and cerebrovascular events (MACCE) and target vessel revascularization (TVR) following HCR.
Main Methods:
- A prospective study of 100 consecutive patients undergoing HCR.
- Coronary artery disease severity was assessed using the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score.
- Long-term outcomes, MACCE, and TVR rates were evaluated at a mean follow-up of 3.5 years.
Main Results:
- No in-hospital mortality was observed. At 3.5 years, the freedom from MACCE rate was 82.6% and freedom from TVR was 86.1%.
- Patients with diabetes mellitus and those with stented non-LAD lesions had a significantly higher risk of TVR.
- While MACCE and TVR rates were higher in patients with intermediate/high SYNTAX scores, this did not reach statistical significance.
Conclusions:
- Hybrid coronary revascularization is a feasible and effective strategy for minimally invasive, complete revascularization, especially in high-risk patients.
- Optimal outcomes are suggested for patients with a SYNTAX score of 22 or less.
- HCR demonstrates promising long-term results, though specific patient factors like diabetes and non-LAD stenting warrant consideration for TVR risk.
Background:
Hybrid coronary revascularization, meaning, left mammary artery on left anterior descending artery combined with non-left anterior descending artery percutaneous coronary intervention stenting, is considered a viable alternative to conventional coronary artery bypass graft surgery or to multivessel percutaneous coronary intervention, to perform a functionally complete revascularization.
Methods:
One hundred consecutive patients underwent hybrid coronary revascularization. Coronary risk was assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score. Long-term outcomes, major adverse cardiac and cerebrovascular events (MACCE) rate, and repeated target vessels revascularization (TVR) rate were evaluated.
Results:
Mean age was 66.3±12.0 years. Mean SYNTAX score was 28.22±7. Mean European System for Cardiac Operative Risk Evaluation II score was 4.05±1.83. Percutaneous coronary intervention was performed in all patients (n=100), in 75% of cases before and in 25% of cases after surgery (interval, 2.2±1.3 months). No in-hospital mortality was reported. At follow-up, 1 cardiac death of acute MI occurred. At 3.5±1.3 years follow-up, overall population freedom from MACCE rate was 82.6% (95% confidence interval [CI]: 79.5% to 85.7%) and the freedom from TVR rate was 86.1% (95% CI: 82.9% to 89.3%). MACCE and TVR rates were higher in patients with intermediate and high coronary risk than in patients with SYNTAX score of 22 or less, although not statistically significant (p>0.05). Cox regression analysis showed a significant increment of risk for TVR on overall population in patients with diabetes mellitus (OR 2.4, 95% CI 1.3-3.5, p=0.03) and in patients with non-left anterior descending artery stented lesions (OR 4.5, with 95% CI 2.8-6.2, p=0.02).
Conclusions:
Hybrid coronary revascularization is a viable option to perform a minimally invasive, functionally complete revascularization in high-risk patients for conventional revascularization, with better results when performed on patients with a SYNTAX score of 22 or less.
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