Hybrid Coronary Revascularization for Multivessel CAD
What are the characteristics and outcomes of patients undergoing clinically indicated hybrid coronary revascularization (HCR) and multivessel percutaneous coronary intervention (PCI) for hybrid-eligible coronary artery disease (CAD)?
Over 18 months, 200 HCR and 98 multivessel PCI patients were enrolled at 11 sites. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE: death, stroke, myocardial infarction, repeat revascularization) within 12 months post-intervention. Cox proportional hazards models were used to model time to first MACCE event. Propensity scores were used to balance the groups.
Mean age was 64.2 ± 11.5 years, 25.5% of patients were female, 38.6% were diabetic, and 4.7% had prior stroke. Thirty-eight percent had three-vessel CAD, and the mean SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was 19.7 ± 9.6. Adjusted for baseline risk, MACCE rates were similar between groups within 12 months post-intervention (hazard ratio [HR], 1.063; p = 0.80) and during a median 17.6 months of follow-up (HR, 0.868; p = 0.53).
The authors concluded that there is no significant difference in MACCE rates over 12 months between patients treated with multivessel PCI or HCR.
This multicenter observational study of HCR and multivessel PCI for patients with hybrid-eligible coronary anatomy reports that risk-adjusted MACCE rates were similar between groups through 12 months of follow-up. During longer follow-up, at 18 months, MACCE-free survival curves for HCR versus PCI began to diverge, with increasing MACCE in the multivessel PCI group. This study provides evidence to support the need for an adequately powered comparative effectiveness trial with longer-term follow-up of HCR versus multivessel PCI.
Keywords: Cardiac Surgical Procedures, Coronary Artery Disease, Ischemia, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Stroke, Treatment Outcome
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