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Updated: Feb 24, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Comparison of Coronary Artery Bypass Graft-First and Percutaneous Coronary Intervention-First Approaches for 2-Stage
Hang Jun Choi1, Joonkyu Kang1, Hyun Song1
1Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Insights
Hybrid coronary revascularization (HCR) outcomes are similar regardless of whether coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) is performed first. This study found no significant differences in clinical outcomes between the two approaches.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) combines coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
- Optimal sequencing of CABG and PCI within HCR remains debated.
- This study compares clinical outcomes based on the initial procedure in HCR.
Purpose of the Study:
- To compare clinical outcomes of CABG-first versus PCI-first approaches in HCR.
- To evaluate the safety and efficacy of different HCR procedural sequences.
Main Methods:
- Retrospective analysis of 80 patients undergoing HCR (May 2010-Dec 2015).
- Groups: CABG-first (12 patients) and PCI-first (68 patients).
- Outcomes assessed: perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and repeat revascularization.
Main Results:
- No significant difference in postoperative bleeding between groups.
- Similar incidence of MACCEs: 8.3% (CABG-first) vs. 7.4% (PCI-first).
- Repeat revascularization rates were 25% (CABG-first) vs. 13.2% (PCI-first), not statistically significant.
Conclusions:
- No significant differences in postoperative or medium-term outcomes between CABG-first and PCI-first HCR.
- Either CABG or PCI can be safely chosen as the primary procedure in staged HCR.
Background:
Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches.
Methods:
Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion.
Results:
No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376).
Conclusion:
There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.
