Long-term survival in triple-vessel disease: Hybrid coronary revascularization compared to contemporary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Hybrid coronary revascularization (HCR) involves grafting the left internal mammary artery to the left anterior descending artery combined with percutaneous coronary intervention (PCI) for other lesions.
• This strategy is infrequently used for complex multivessel disease.
• The study compares HCR to traditional coronary artery bypass grafting (CABG) and multivessel PCI for triple-vessel disease (TVD).

Purpose of the Study:

• To evaluate the 8-year survival rates of patients with TVD treated with HCR.
• To compare HCR outcomes against matched cohorts undergoing traditional CABG or multivessel PCI.
• To assess long-term major adverse cardiovascular events in TVD patients treated with HCR versus CABG or multivessel PCI.

Main Methods:

• Retrospective review of 4805 TVD patients from January 2009 to December 2016.
• Propensity-matched analysis of 100 HCR patients against CABG or multivessel PCI cohorts.
• Primary endpoint: all-cause mortality at 8 years; secondary endpoint: composite of death, repeat revascularization, and myocardial infarction.

Main Results:

• Similar 8-year mortality rates observed: HCR (5.0%), CABG (4.0%), and multivessel PCI (9.0%).
• No significant difference in the composite endpoint of death, repeat revascularization, or myocardial infarction between groups.
• HCR achieved a lower residual SYNTAX score compared to multivessel PCI, despite a higher baseline SYNTAX score.

Conclusions:

• HCR demonstrates comparable long-term survival and freedom from major adverse cardiovascular events to traditional CABG and multivessel PCI in select TVD patients.
• HCR should be considered for patients with multivessel disease when a low residual SYNTAX score is achievable.
• The findings support HCR as a valuable treatment option for specific complex coronary artery disease cases.