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Outcome of hybrid compared to conventional revascularization in multivessel coronary artery disease
Ivy Susanne Modrau1,2, Per Hostrup Nielsen1, Dorthe Viemose Nielsen3
1Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Insights
Hybrid myocardial revascularization (HMR) showed no difference in major adverse cardiovascular events compared to coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) at 3 years.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Multivessel coronary artery disease requires effective revascularization strategies.
- Hybrid myocardial revascularization (HMR) combines surgical and percutaneous approaches.
- Comparing HMR to conventional methods is crucial for treatment selection.
Purpose of the Study:
- To evaluate the 3-year clinical outcomes of HMR versus conventional revascularization.
- To compare major adverse cardiovascular and cerebrovascular events (MACCE) rates.
- To assess secondary endpoints including acute kidney injury and readmissions.
Main Methods:
- Retrospective matched cohort study of 103 patients undergoing staged HMR.
- Comparison with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) groups matched for disease severity and comorbidities.
- Utilized the Western Denmark Heart Registry for patient identification and follow-up.
Main Results:
- No significant difference in MACCE rates at 3 years between HMR (31.1%), CABG (20.4%), and PCI (20.4%).
- HMR showed increased rates of repeat revascularization compared to CABG.
- CABG group had fewer cardiovascular readmissions but higher acute kidney injury incidence.
Conclusions:
- HMR is not superior to CABG or PCI regarding 3-year MACCE.
- HMR may be a safe alternative considering procedure-specific morbidity.
- Treatment choice should weigh efficacy and complication profiles.
Objectives:
Evaluation of 3-year clinical outcome of hybrid myocardial revascularization (HMR) compared to conventional revascularization strategies in patients with multivessel coronary artery disease involving the proximal left anterior descending artery. Design. Retrospective matched cohort study based on a prospective feasibility study including 103 elective patients undergoing staged HMR from October 2010 until February 2012. The Western Denmark Heart Registry was used to identify patients who underwent coronary artery bypass grafting (CABG) and multivessel percutaneous coronary intervention (PCI) by matching on number of diseased vessels, age and comorbidity score. Primary endpoint was the composite rate of major adverse cardiovascular and cerebrovascular events (MACCE) at 3-year follow-up. Secondary endpoints included individual MACCE components, acute kidney injury, and cardiovascular readmissions. Results. There was no difference between MACCE in the three groups (HMR 31.1%; CABG 20.4%; PCI 20.4%, p = .11). Estimates of repeat revascularization were significantly increased with HMR versus CABG. In the CABG group, fewest patients required cardiovascular readmissions though with the highest incidence of acute kidney injury. Conclusions. HMR was not superior with respect to MACCE compared with CABG and PCI. It may, however, represent a safe alternative to conventional revascularization treatment considering the specific procedure-associated morbidity.
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