HREVS: PCI, CABG or Hybrid Coronary Revascularization in Patients With Multivessel CAD?
One-year outcomes were similar in patients with multivessel coronary artery disease who were treated with either percutaneous coronary intervention (PCI), CABG or hybrid coronary revascularization based on findings from the HREVS Trial presented at TCT 2017 in Denver.
Researchers randomized 155 patients to either CABG (50), PCI (53) or hybrid coronary revascularization (52). The primary endpoint was residual myocardial ischemia by SPECT at 12 months, with secondary endpoints of death, myocardial infarction, stroke, clinically-driven target vessel revascularization, and target vessel or graft failure.
Overall results found no significant differences in residual myocardial ischemia and major adverse cardiovascular events across all three study arms at 30 days and 12 months. However, there was a lower rate of bleeding in the hybrid coronary revascularization group compared to CABG, as well as five patients in the hybrid coronary revascularization group who required conversion to conventional on-pump CABG with a median sternotomy.
Vladimir Ganyukov, MD, PhD, who presented the study findings, also noted shorter hospitalization stays and sick-leave durations among patients who underwent PCI – a finding he suggests may have health care system benefits. However, he said extended follow-up is needed to determine longer-term outcomes. ACC.org Editor-in-Chief Kim Eagle, MD, FACC, agrees, noting HREVS findings must be tempered by the small number of patients in each arm.
Keywords: TCT17, Transcatheter Cardiovascular Therapeutics, Coronary Vessels, Coronary Restenosis, Stents
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