Hybrid Revascularization: 5-Year Outcomes

Study Questions:

What are 5-year clinical outcomes among patients with multivessel coronary artery disease (CAD) undergoing a complete surgical revascularization approach compared to a hybrid approach?

Methods:

This was a 5-year follow-up analysis of the patients enrolled in the original HYBRID (Hybrid Revascularization for Multivessel Coronary Artery Disease) trial. The original trial evaluated the feasibility of a hybrid approach among patients with multivessel CAD. Two-hundred patients were randomly assigned to conventional coronary artery bypass grafting (CABG) versus hybrid coronary revascularization (HCR) (minimally invasive left internal mammary artery [LIMA] to left anterior descending artery [LAD] + percutaneous coronary intervention [PCI]). This analysis focused on 5-year outcomes among the cohort enrolled.

Results:

Data from 191 patients (94 in the HCR and 97 in the CABG group) were analyzed. The baseline characteristics were similar in the two groups. All-cause mortality at 5-year follow-up was similar in the two groups (6.4% for HCR vs. 9.2% for CABG; p = 0.69). The rates of myocardial infarction (4.3% vs. 7.2%; p = 0.30), repeat revascularization (37.2% vs. 45.4%; p = 0.38), stroke (2.1% vs. 4.1%; p = 0.35), and major adverse cardiac and cerebrovascular events (45.2% vs. 53.4%; p = 0.39) were also similar in the two groups.

Conclusions:

HCR continues to show similar outcomes when compared to CABG after 5 years.

Perspective:

These are reassuring results for longer-term outcomes, building on the findings from the original HYBRID trial. Patients in the HCR group underwent minimally invasive LIMA to LAD followed by PCI. The reluctance and concern with a hybrid approach has centered around several factors including surgical expertise with minimally invasive LIMA to LAD, issues surrounding bleeding given the need for dual antiplatelet therapy, and appropriate timing. Combining the most advantageous aspects of surgical revascularization (LIMA to LAD) and the advantages of contemporary drug-eluting stent PCI (superior patency compared to saphenous vein graft) can serve to be the right approach in selected patients with multivessel CAD. This approach predicates on collaboration between the surgical team and interventional cardiology.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Coronary Artery Disease, Drug-Eluting Stents, Hemorrhage, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Stroke, Treatment Outcome


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