Related Experiment Video
Updated: May 11, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Staged Hybrid Coronary Revascularization in Acute Coronary Syndrome
Michele Rossi1, Vincenzo Calabrese2, Giovanni Tripepi3
1Department of Cardiac Surgery, Heart Center, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy.
Insights
Staged hybrid coronary revascularization (HCR) is safe and effective for treating complex acute coronary syndrome (ACS) patients unsuitable for standard bypass surgery. This approach offers comparable long-term survival to traditional coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute coronary syndrome (ACS) presents treatment challenges in patients with complex left anterior descending artery (LAD) lesions or non-LAD culprit lesions unsuitable for standard coronary artery bypass grafting (CABG).
- Staged hybrid coronary revascularization (HCR), a combined approach of percutaneous coronary intervention and CABG, emerges as a viable alternative for this patient subgroup.
Purpose of the Study:
- To compare the effectiveness and safety of staged hybrid coronary revascularization (HCR) versus conventional coronary artery bypass grafting (CABG) alone in patients with complex coronary artery disease.
- To evaluate major adverse cardiac and cerebrovascular events (MACCE) and in-hospital postoperative complications between the two treatment strategies.
Main Methods:
- A retrospective observational study comparing 65 patients who underwent HCR with 274 patients who underwent CABG alone between December 2016 and December 2021.
- Primary outcomes included MACCE at 30 days and long-term follow-up. Secondary outcomes assessed in-hospital postoperative complications and blood transfusion requirements.
Main Results:
- While preoperative EuroSCORE II was higher in the HCR group (3.4 vs. 2.5, P < .05), indicating higher surgical risk, patients in the CABG group required more blood transfusions (P = .004).
- No significant differences were observed in in-hospital postoperative complications between the HCR and CABG groups.
- Survival analysis revealed no significant differences in MACCE at 30 days (HR, 0.51; P = .52) or long-term follow-up (up to 5 years; HR, 0.40; P = .21) between the HCR and CABG groups.
Conclusions:
- Staged hybrid coronary revascularization (HCR) demonstrates safety and effectiveness in managing selected ACS patients with complex coronary lesions.
- HCR offers comparable long-term survival outcomes to traditional CABG, supporting its role as an attractive treatment option for this challenging patient population.
Background:
In acute coronary syndrome (ACS) with non-ST elevation myocardial infarction, there is a subgroup of patients who are difficult to treat; these are patients with a complex left anterior descending artery (LAD) lesion or a non-LAD culprit lesion but who are not suitable for standard coronary artery bypass grafting (CABG). Staged hybrid coronary revascularization (HCR), combining primary percutaneous coronary intervention on the non-LAD culprit lesion with CABG, represents an attractive solution.
Methods:
We conducted a retrospective observational study to compare effectiveness and safety of HCR vs CABG alone. From December 6, 2016, to December 21, 2021, at our institution, 339 patients underwent urgent CABG with or without previous primary percutaneous coronary intervention; 65 received HCR (study group) and 274 received CABG alone (control group). Primary outcomes were major adverse cardiac and cerebrovascular events at 30 days and at long-term follow-up. Secondary outcomes were in-hospital postoperative complications.
Results:
Significant preoperative differences were detected in the mean EuroSCORE II: 3.4 (1.5-7.8) in HCR vs 2.5 (1.1-4.5) in CABG (P < .05). Patients in the CABG group needed more blood transfusions than patients in the HCR group (P = .004). Conversely, no other significant differences were detected for in-hospital postoperative complications. Survival analysis did not show significant differences between HCR and CABG, either to 30 days (hazard ratio, 0.51 [95% CI, 0.03-4.04]; P = .52) or to longer follow-up (maximum 5 years; hazard ratio, 0.40 [95% CI, 0.09-1.68]; P = .21).
Conclusions:
Our data support the safety and effectiveness of staged HCR in the scenario of ACS.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management