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Hybrid coronary revascularization versus percutaneous strategies in left main stenosis: a propensity match study
Alberto Repossini1, Lorenzo Di Bacco1, Fabrizio Rosati1
1Clinical Department of Cardiovascular Surgery, Cardiac Surgery Unit ,University of Brescia.
Insights
Hybrid coronary revascularization (HCR) shows better outcomes than percutaneous coronary intervention (PCI) for left main treatment in high-risk patients. HCR significantly reduced major adverse cardiac and cerebrovascular events (MACCEs) and target vessel revascularization (TVR).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Multivessel coronary disease often involves the left main artery, posing complex treatment challenges.
- Hybrid coronary revascularization (HCR) is emerging as an alternative to traditional percutaneous coronary intervention (PCI) for left main disease, especially in high-risk patients.
Purpose of the Study:
- To compare the clinical outcomes of HCR versus PCI with drug-eluting stenting in patients with left main coronary artery stenosis.
- To evaluate the efficacy and safety of HCR in treating complex coronary artery disease.
Main Methods:
- A cohort of 198 patients with left main stenosis was analyzed.
- 77 patients underwent HCR (G1), while 121 patients received PCI (G2).
- Outcomes including 30-day mortality, myocardial infarction, and 18-month major adverse cardiac and cerebrovascular events (MACCEs) were assessed using inverse probability weighting (IPW).
Main Results:
- No significant difference in SYNTAX scores between HCR and PCI groups.
- HCR group showed no mortality at 18 months, while the PCI group had a 2.7% mortality rate due to cardiogenic shock within 30 days.
- Survival free from MACCEs at 18 months was significantly higher in the HCR group (93.3%) compared to the PCI group (72.3%), primarily due to lower rates of target vessel revascularization (TVR).
- PCI was identified as an independent predictor of MACCEs and TVR.
Conclusions:
- While PCI is a viable option for left main disease, HCR demonstrated a superior safety profile with a lower incidence of adverse cardiac events like myocardial infarction and TVR.
- HCR may offer better long-term outcomes for selected patients with left main and multivessel disease.
- Further comparative studies are warranted to define the optimal patient population for HCR.
Aims:
Hybrid revascularization (HCR) has been recently proposed as an alternative strategy in multivessel coronary disease, particularly in patients with high SYNTAX scores and risk scores. The objective of this study is to evaluate the outcomes of HCR versus percutaneous coronary intervention (PCI) drug-eluting stenting in left main treatment.
Methods:
A series of 198 consecutive patients with left main stenosis have been treated. HCR, was performed in 77 patients (G1) whereas 121 patients (G2) received PCI on left main. An adjusted analysis using inverse probability weighting (IPW) was performed. Primary outcomes include: 30-day mortality, postoperative acute myocardial infarction, 18 months' MACCEs: cardiac death, stroke, acute myocardial infarction (AMI), repeated target vessel revascularization (TVR).
Results:
SYNTAX score was 29.5 ± 6.9 in G1 and 29.1 ± 6.5 in G2 (P = 0.529). In G2, three patients (2.7%) died because of cardiogenic shock; no deaths occurred in G1 (P = 0.603). No major complications were reported in G1 and there was no mortality at 18 months' follow-up in both groups. Survival freedom from MACCEs at 18 months' follow-up was significantly higher in G1 (G1: 93.3 ± 4.6% versus G2: 72.3 ± 6.3; P = 0.001) mostly because of the higher freedom from TVR (G1: 93.3 ± 4.6% versus G2: 75.5 ± 5.6; P = 0.002). At Cox regression analysis, PCI was an independent predictor of MACCEs and TVR (hazard ratio 3.9, CI 1.36-9.6; P = 0.027).
Conclusion:
PCI in patients with left main and multivessel disease is a viable strategy, with a good outcome. HCR, demonstrated a lower incidence of cardiac adverse events such as AMI and TVR. Future comparative studies will be helpful to identify the optimal patient population for HCR.
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