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Updated: Apr 1, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
One-year clinical and angiographic results of hybrid coronary revascularization
Ivy S Modrau1, Niels R Holm2, Michael Mæng2
1Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Insights
Hybrid coronary revascularization (HCR) showed a 98% left internal mammary artery graft patency and low death/stroke risk at 1 year. However, repeat revascularization rates were high, particularly for non-left anterior descending lesions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Hybrid coronary revascularization (HCR) combines surgical and percutaneous approaches for multivessel coronary artery disease.
- Evaluating the clinical and angiographic outcomes of HCR is crucial for optimizing treatment strategies.
Purpose of the Study:
- To assess the 1-year clinical and angiographic results of hybrid coronary revascularization (HCR).
- HCR involves off-pump left internal mammary artery (LIMA) grafting and percutaneous coronary intervention (PCI).
Main Methods:
- A prospective, single-arm feasibility study included 100 patients with multivessel disease undergoing staged HCR.
- The primary endpoint was the composite rate of major adverse cardiac and cerebrovascular events at 1 year.
- Secondary endpoints included mortality, stroke, myocardial infarction, repeat revascularization, and graft/stent patency.
Main Results:
- The 1-year composite endpoint occurred in 20% of patients.
- Individual events included 1 death, 1 stroke, 3 myocardial infarctions, and 16 repeat revascularizations (surgical or PCI).
- Left internal mammary artery graft patency was high at 98%, while PCI restenosis occurred in 10% of lesions.
Conclusions:
- Angiographically controlled HCR demonstrated high LIMA graft patency and low risks of death and stroke at 1 year.
- The study identified a high rate of repeat revascularization as a key challenge.
- Revascularization of non-left anterior descending coronary artery lesions requires further optimization within the HCR strategy.
Objective:
To evaluate 1-year clinical and angiographic results after hybrid coronary revascularization (HCR) combining off-pump left internal mammary artery (LIMA) grafting through an inferior J-hemisternotomy with percutaneous coronary intervention (PCI).
Methods:
Prospective, single-arm clinical feasibility study including 100 consecutive patients with multivessel disease undergoing staged HCR. The primary endpoint was the major adverse cardiac and cerebrovascular event rate at 1 year. Secondary endpoints included 1-year all-cause death, stroke, myocardial infarction, repeat revascularization, and angiographic graft and stent patency.
Results:
One-year clinical follow-up data were available in all patients. The primary endpoint was met by 20 patients (20%). Individual endpoints were as follows: 1 death due to heart failure; 1 stroke, 2 procedure-related myocardial infarctions; and 1 spontaneous myocardial infarction during follow-up. A total of 16 patients underwent repeat revascularization: 5 surgical reinterventions during the index hospitalization for angiographically suspected internal mammary artery graft dysfunction, and 3 repeat PCIs. Only 1 patient had evidence of ischemia. After discharge, PCI was performed in 6 patients who had recurrent angina, and in 2 asymptomatic patients who had angiographic restenosis. At the 1-year angiographic follow-up, 87 of 89 (98%) patients had patent internal mammary artery grafts. Angiographic restenosis was present in 10 of 100 lesions treated by PCI.
Conclusions:
Angiographically controlled HCR was associated with a high repeat revascularization rate. The 1-year 98% LIMA-graft patency rate, and low risk of death and stroke, seem promising for the long-term outcome. Non-left anterior descending coronary artery lesion revascularization remains a challenge.
