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Published on: March 27, 2018
Hybrid Coronary Revascularization Versus Conventional Coronary Artery Bypass Surgery: Utilization and Comparative
Edward L Hannan1, Yifeng Wu1, Kimberly Cozzens1
1School of Public Health, University at Albany, State University of New York, NY (E.L.H., Y.W., K.C.).
Insights
Hybrid coronary revascularization (HCR) showed similar 6-year survival to conventional coronary artery bypass grafting (CABG) but had higher late mortality and repeat revascularization rates. HCR is rarely used for multivessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Outcomes Research
Background:
- Hybrid coronary revascularization (HCR) combines minimally invasive surgery and percutaneous coronary intervention for multivessel coronary artery disease.
- Conventional coronary artery bypass grafting (CABG) is a standard treatment for multivessel coronary artery disease.
Purpose of the Study:
- To compare the medium-term outcomes of HCR versus conventional CABG in patients with multivessel coronary artery disease.
- To evaluate differences in mortality and repeat revascularization rates between HCR and CABG.
Main Methods:
- Utilized data from New York's cardiac surgery and percutaneous coronary intervention registries (2010-2016).
- Compared mortality and repeat revascularization rates using propensity matching to mitigate selection bias.
- Analyzed outcomes for 303 HCR patients and 37,556 conventional CABG patients.
Main Results:
- No significant difference in 6-year survival between HCR and conventional CABG (80.9% vs. 85.8%).
- HCR demonstrated higher mortality after the first year (adjusted hazard ratio, 1.88).
- Conventional CABG patients had significantly lower rates of repeat revascularization at 6 years (88.2% vs. 76.6%).
Conclusions:
- HCR is infrequently utilized for multivessel coronary artery disease.
- While 6-year mortality is similar, HCR is associated with increased late mortality and higher rates of subsequent revascularization.
- Findings suggest careful consideration of HCR's risks and benefits in patient selection for multivessel coronary artery disease.
Background:
Hybrid coronary revascularization (HCR) treats multivessel coronary artery disease by combining a minimally invasive surgical approach to the left anterior descending artery with percutaneous coronary intervention for non-left anterior descending diseased coronary arteries. The objective of this study is to compare HCR and conventional coronary artery bypass graft (CABG) surgery medium-term outcomes.
Methods:
Data from multivessel disease patients in New York's cardiac surgery and percutaneous coronary intervention registries in 2010 to 2016 were used to compare mortality and repeat revascularization rates for HCR and conventional CABG after using propensity matching to reduce selection bias.
Results:
There was a total of 303 HCR (0.80%) patients and 37 556 conventional CABG patients after exclusions. After propensity matching, the respective median follow-up times were 3.72 years and 3.76 years. There was no difference between HCR and conventional CABG in survival at 6 years (80.9% versus 85.8%%, adjusted hazard ratio, 1.44 [0.90-2.31]), but HCR had higher mortality excluding deaths during the first year (adjusted hazard ratio, 1.88 [1.10-3.23]). Conventional CABG patients were more likely to be free from repeat revascularization at 6 years than HCR patients (88.2% versus 76.6%; hazard ratio, 2.22 [1.44-3.42]).
Conclusions:
HCR is rarely performed for patients with multivessel coronary artery disease. HCR and conventional CABG had no different 6-year mortality rates, but HCR had higher mortality after 1 year and higher rates of subsequent revascularization that were caused by both the need for repeat revascularization in the left anterior descending artery where minimally invasive CABG was performed, and in the coronary arteries where percutaneous coronary intervention was performed. Graphic Abstract: A graphic abstract is available for this article.
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