Hybrid revascularization for multivessel coronary artery disease
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Mariusz Gąsior1, Michael Oscar Zembala2, Mateusz Tajstra1
1Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Insights
Hybrid coronary revascularization (HCR) is a feasible option for select patients with multivessel coronary artery disease (MVCAD). This approach demonstrated comparable safety and efficacy to conventional coronary artery bypass grafting (CABG) at 12 months.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Coronary artery bypass grafting (CABG) is standard for multivessel coronary artery disease (MVCAD).
- Limitations exist with conventional CABG, including saphenous graft patency.
- Alternative revascularization strategies are being explored.
Purpose of the Study:
- To assess the feasibility of hybrid coronary revascularization (HCR) in MVCAD patients.
- To compare HCR safety and efficacy against standard CABG.
- To evaluate major adverse cardiac events following HCR versus CABG.
Main Methods:
- 200 MVCAD patients referred for CABG were randomized to HCR or CABG (1:1 ratio).
- Inclusion criteria involved left anterior descending artery (LAD) and other major vessel lesions.
- Primary endpoint was HCR safety; feasibility defined by procedure completion and conversion rates. Major adverse cardiac events were tracked for 12 months.
Main Results:
- 93.9% of patients in the HCR group completed the procedure; 6.1% were converted to standard CABG.
- At 12 months, death rates (2.0% vs. 2.9%), myocardial infarction (6.1% vs. 3.9%), and major bleeding (2% vs. 2%) were similar between groups.
- No significant differences in repeat revascularization (2% vs. 0%) or cerebrovascular incidents were observed.
Conclusions:
- Hybrid coronary revascularization (HCR) is feasible in carefully selected MVCAD patients.
- HCR offers a viable alternative to conventional CABG for specific patient profiles.
- The study supports HCR as a safe and effective revascularization strategy.
Objectives:
The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).
Background:
Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known.
Methods:
A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed.
Results:
Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed.
Conclusions:
HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567).
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