Randomized Clinical Trial of Hybrid vs. Surgical vs. Percutaneous Multivessel Coronary Revascularization: 5‑year
V I Ganyukov1, N A Kochergin1, A A Shilov1
1"Scientific Research Institute of Complex Problems of Cardiovascular Diseases", Kemerovo.
Insights
Hybrid coronary revascularization (HCR) shows promising 5-year results for multivessel coronary artery disease, comparable to coronary artery bypass grafting (CABG) and superior to percutaneous coronary intervention (PCI). Further large-scale studies are needed to confirm its efficacy.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Multivessel coronary artery disease requires effective revascularization strategies.
- Comparing traditional methods like CABG and PCI with newer hybrid approaches is crucial for patient outcomes.
- The HREVS study aimed to provide long-term comparative data on these interventions.
Purpose of the Study:
- To evaluate the 5-year clinical outcomes of hybrid coronary revascularization (HCR) compared to coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- To assess residual ischemia and major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel coronary artery disease.
Main Methods:
- 155 patients with multivessel coronary artery disease were randomized into three groups: CABG (n=50), HCR (n=52), and PCI (n=53).
- Primary endpoint: residual ischemia at 12 months (SPECT).
- Secondary endpoints: 5-year MACCE (all-cause death, myocardial infarction, stroke, repeat revascularization).
Main Results:
- No significant difference in residual ischemia at 12 months between CABG, HCR, and PCI groups (p=0.45).
- No significant differences in all-cause mortality, myocardial infarction, stroke, or repeat revascularization rates among the three groups over 5 years.
- Cumulative 5-year MACCE was similar for HCR and CABG, but significantly lower than for PCI (p=0.03).
Conclusions:
- Hybrid coronary revascularization (HCR) is a promising strategy for multivessel coronary artery disease, combining benefits of PCI and CABG.
- HCR demonstrated satisfactory long-term results comparable to CABG and superior to PCI in terms of MACCE.
- Larger multicenter studies are required to definitively confirm the safety and efficacy of HCR for clinical endpoints.
Abstract:
Aim To evaluate 5-year results of the HREVS (Hybrid REvascularization Versus Standarts) study.Material and methods The study included 155 consecutive patients with multivessel coronary artery disease who were randomized into 3 groups: coronary artery bypass grafting (CABG) (n=50), hybrid coronary revascularization (HCR) (n=52) and percutaneous coronary intervention (PCI) (n=53) according to the consensus of the cardiology team on the technical and clinical feasibility of each of the three coronary revascularization strategies. The primary endpoint of the study was residual ischemia 12 months after revascularization according to data of single-photon emission computed tomography (SPECT). Secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) over 5 years of follow-up, which included all-cause death, myocardial infarction, stroke, and clinically determined repeat myocardial revascularization.Results Baseline characteristics of patients did not differ between study groups. Median residual ischemia determined by SPECT data after 12 months was not statistically significantly different in the CABG, HCR and PCI groups: 6.7 [4.6; 8.8]%, 6.4 [4.3; 8.5]% and 7.9 [5.9; 9.8]%, respectively (p=0.45). Mean follow-up period was 76.5 months (at least 60 months). There were no statistically significant differences in all-cause mortality between the CABG, HCR and PCI groups, 10.6, 12.8 and 8.2 %, respectively (p=0.23). Statistically significant differences between the groups of CABG, HCR and PCI in the incidence of myocardial infarction (12.8; 8.5 and 16.3 %; p=0.12), stroke (4.2; 6.4 and 10.2 % ; p=0.13), repeat revascularization for clinical indications (23.4; 23.4 and 34.7 %; p=0.11) were not observed either. However, the cumulative 5-year MACCE value was similar in the HCR group and the CABG group but significantly lower than in the PCI group (51.1, 51.1 and 69.4 %, respectively; p = 0.03).Conclusion HCR that combines advantages of PCI and CABG is a promising strategy for coronary revascularization in multivessel coronary artery disease. HCR demonstrates satisfactory long-term results comparable to those of CABG but superior to PCI. To confirm the safety and efficacy of HCR, a large multicenter study is required that would have a sufficient power to evaluate clinical endpoints.
