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Updated: Mar 1, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Hybrid Coronary Revascularization has Improved Short-term Outcomes but Worse Mid-term Reintervention Rates Compared
Yu Xia1, Abraham N Katz, Stephen J Forest
1From the *Department of Cardiothoracic and Vascular Surgery, and †Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY USA.
Insights
Hybrid coronary revascularization offers better short-term outcomes than conventional bypass grafting, with similar survival rates. However, patients undergoing hybrid procedures may require reintervention sooner.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Multivessel coronary artery disease requires effective revascularization strategies.
- Hybrid coronary revascularization (HCR) combines surgical and percutaneous approaches.
- Conventional coronary artery bypass grafting (CABG) is a standard treatment.
Purpose of the Study:
- To compare short-term outcomes and mid-term survival between HCR and CABG.
- To evaluate reintervention rates in patients undergoing HCR versus CABG.
- To utilize a propensity score-matched cohort for robust comparison.
Main Methods:
- Retrospective review of patients with multivessel coronary artery disease (2007-2015).
- Propensity score matching (1:1) of HCR and CABG patients based on preoperative characteristics.
- Comparison of short-term outcomes, 30-day mortality, readmission, and mid-term survival using Kaplan-Meier and Cox regression.
Main Results:
- HCR group showed shorter postoperative length of stay (4 vs 5 days) and less transfusion.
- Higher discharge home rate (93.4% vs 71.4%) in HCR group.
- No significant difference in 30-day mortality or mid-term survival; HCR associated with earlier reintervention (HR 3.60).
Conclusions:
- HCR demonstrates favorable short-term outcomes and similar survival to CABG.
- HCR may be associated with an increased likelihood of earlier reintervention.
- Careful patient selection and follow-up are crucial for HCR.
Objective:
We evaluated short-term outcomes and mid-term survival and reintervention of hybrid coronary revascularization versus conventional coronary artery bypass grafting using a propensity score matched cohort.
Methods:
We conducted a retrospective review of patients undergoing surgery for multivessel coronary artery disease from 2007 to 2015 at a single institution. Patients were propensity matched 1:1 to receiving hybrid coronary revascularization or conventional bypass grafting by multivariate logistic regression on preoperative characteristics. Short-term outcomes were compared. Freedom from reintervention and death were assessed by Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression.
Results:
Propensity score matching selected 91 patients per group from 91 hybrid and 2601 conventionally revascularized patients. Hybrid revascularization occurred with surgery first in 56 (62%), percutaneous intervention first in 32 (35%), and simultaneously in 3 (3%) patients. Median intervals between interventions were 3 and 36 days for surgery first and percutaneous intervention first, respectively. Preoperative characteristics were similar. Patients undergoing hybrid revascularization had shorter postoperative length of stay (median = 4 vs 5 days, P < 0.001), less postoperative transfusion (13.2% vs 34.1%, P = 0.001), and respiratory failure (0% vs 6.6%, P = 0.03). They were more likely to be discharged home (93.4% vs 71.4%, P < 0.001), with no difference in 30-day mortality (P = 0.99), readmission (P = 0.23), or mid-term survival (P = 0.79). Hybrid revascularization was associated with earlier reintervention (P = 0.02). Hazard ratios for reintervention and patient mortality of hybrid coronary revascularization versus conventional revascularization were 3.60 (95% confidence interval = 1.16-11.20) and 1.17 (95% confidence interval = 0.37-3.72), respectively.
Conclusions:
Despite having favorable short-term outcomes and similar survival, hybrid coronary revascularization may be associated with earlier reintervention compared with conventional techniques.
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