Hybrid coronary revascularization in 100 patients with multivessel coronary disease

Background: Hybrid coronary revascularization, meaning, left mammary artery on left anterior descending artery combined with non-left anterior descending artery percutaneous coronary intervention stenting, is considered a viable alternative to conventional coronary artery bypass graft surgery or to multivessel percutaneous coronary intervention, to perform a functionally complete revascularization.

Methods: One hundred consecutive patients underwent hybrid coronary revascularization. Coronary risk was assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score. Long-term outcomes, major adverse cardiac and cerebrovascular events (MACCE) rate, and repeated target vessels revascularization (TVR) rate were evaluated.

Results: Mean age was 66.3±12.0 years. Mean SYNTAX score was 28.22±7. Mean European System for Cardiac Operative Risk Evaluation II score was 4.05±1.83. Percutaneous coronary intervention was performed in all patients (n=100), in 75% of cases before and in 25% of cases after surgery (interval, 2.2±1.3 months). No in-hospital mortality was reported. At follow-up, 1 cardiac death of acute MI occurred. At 3.5±1.3 years follow-up, overall population freedom from MACCE rate was 82.6% (95% confidence interval [CI]: 79.5% to 85.7%) and the freedom from TVR rate was 86.1% (95% CI: 82.9% to 89.3%). MACCE and TVR rates were higher in patients with intermediate and high coronary risk than in patients with SYNTAX score of 22 or less, although not statistically significant (p>0.05). Cox regression analysis showed a significant increment of risk for TVR on overall population in patients with diabetes mellitus (OR 2.4, 95% CI 1.3-3.5, p=0.03) and in patients with non-left anterior descending artery stented lesions (OR 4.5, with 95% CI 2.8-6.2, p=0.02).

Conclusions: Hybrid coronary revascularization is a viable option to perform a minimally invasive, functionally complete revascularization in high-risk patients for conventional revascularization, with better results when performed on patients with a SYNTAX score of 22 or less.