Hybrid revascularization for multivessel coronary artery disease
Mariusz Gąsior, Michael Oscar Zembala, Mateusz Tajstra, Krzysztof Filipiak, Marek Gierlotka, Tomasz Hrapkowicz, Michał Hawranek, Lech Poloński, Marian Zembala, POL-MIDES (HYBRID) Study Investigators, Mariusz Gąsior, Michael Oscar Zembala, Mateusz Tajstra, Krzysztof Filipiak, Marek Gierlotka, Tomasz Hrapkowicz, Michał Hawranek, Lech Poloński, Marian Zembala, POL-MIDES (HYBRID) Study Investigators
Abstract
Objectives: The aim of this study was to assess the feasibility of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD) referred for standard coronary artery bypass grafting (CABG).
Background: Conventional CABG is still the treatment of choice in patients with MVCAD. However, the limitations of standard CABG and the unsatisfactory long-term patency of saphenous grafts are commonly known.
Methods: A total of 200 patients with MVCAD involving the left anterior descending artery (LAD) and a critical (>70%) lesion in at least 1 major epicardial vessel (except the LAD) amenable to both PCI and CABG and referred for conventional surgical revascularization were randomly assigned to undergo HCR or CABG (in a 1:1 ratio). The primary endpoint was the evaluation of the safety of HCR. The feasibility was defined by the percent of patients with a complete HCR procedure and the percent of patients with conversions to standard CABG. The occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeated revascularization, and major bleeding within the 12-month period after randomization was also assessed.
Results: Most of the pre-procedural characteristics were similar in the 2 groups. Of the patients in the hybrid group, 93.9% had complete HCR and 6.1% patients were converted to standard CABG. At 12 months, the rates of death (2.0% vs. 2.9 %, p = NS), myocardial infarction (6.1% vs. 3.9%, p = NS), major bleeding (2% vs. 2%, p = NS), and repeat revascularization (2% vs. 0%, p = NS) were similar in the 2 groups. In both groups, no cerebrovascular incidents were observed.
Conclusions: HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567).
Keywords: CABG; PCI; hybrid revascularization; multivessel coronary artery disease.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed