Contemporary Use of Hybrid Revascularization Characterized Using NCDR Data

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Hybrid revascularization, combining PCI and CABG, for the treatment of multivessel coronary artery disease, is used infrequently. According to a new analysis, while the risk-adjusted in-hospital mortality rate was not different between hybrid revascularization and multivessel PCI, patients who had hybrid revascularization were less likely to receive P2Y12 inhibitors at discharge. The findings were published in the American Heart Journal.

Angela Lowenstern, MD, et al., used data from ACC's CathPCI Registry from 2009 to 2017 to review the treatment of 775,000 patients with multivessel CAD. Of those patients, 1,126 (0.2 percent) had hybrid revascularization and 256,865 (33 percent) were treated using multivessel PCI. Patients undergoing hybrid revascularization were younger and they were more likely to have significant left main disease or proximal left anterior descending disease.

Of the patients treated with hybrid revascularization, two-thirds (68.7 percent) had a CABG procedure after PCI – but only 79.4 percent were prescribed a P2Y12 inhibitor at discharge. There was also a lower rate of discharge P2Y12 use in patients who hybrid revascularization vs. multivessel PCI (83.1 percent vs. 98.0 percent; p<0.001).

Unadjusted in-hospital mortality rates were higher among patients treated with hybrid revascularization than multivessel PCI (1.5 percent vs. 0.9 percent), which was not significant after multivariable adjustment. Risk-adjusted mortality did not differ in relation to the order of revascularization among those who had hybrid revascularization.

Researchers observed limited use of hybrid coronary revascularization in contemporary clinical practice. Of the 711 hospitals performing nonemergency PCIs, only 358 performed at least one hybrid revascularization during the study period. Approximately one-third of hybrid revascularizations were performed as CABG followed by PCI and two-thirds had CABG performed following PCI.

"Further work is necessary to fully clarify the comparative effectiveness of hybrid coronary revascularization versus multivessel PCI and the patient populations where hybrid coronary revascularization is most beneficial, and to optimize the postprocedural medical management and outcomes of these patients," researchers concluded.

Keywords: CathPCI Registry, National Cardiovascular Data Registries, Coronary Artery Disease, Hospital Mortality, Risk Adjustment, Registries, Percutaneous Coronary Intervention, Angiography

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