One-year clinical and angiographic results of hybrid coronary revascularization
Ivy S Modrau, Niels R Holm, Michael Mæng, Hans E Bøtker, Evald H Christiansen, Steen D Kristensen, Jens F Lassen, Leif Thuesen, Per H Nielsen, Hybrid Coronary Revascularization Study Group, Vibeke E Hjortdal, Christian Juhl Terkelsen, Anne Kjer Kaltoft, Lars Romer Krusell, Henning Skov Kelbæk, Lone Kærslund Andersen, Ivy S Modrau, Niels R Holm, Michael Mæng, Hans E Bøtker, Evald H Christiansen, Steen D Kristensen, Jens F Lassen, Leif Thuesen, Per H Nielsen, Hybrid Coronary Revascularization Study Group, Vibeke E Hjortdal, Christian Juhl Terkelsen, Anne Kjer Kaltoft, Lars Romer Krusell, Henning Skov Kelbæk, Lone Kærslund Andersen
Abstract
Objective: To evaluate 1-year clinical and angiographic results after hybrid coronary revascularization (HCR) combining off-pump left internal mammary artery (LIMA) grafting through an inferior J-hemisternotomy with percutaneous coronary intervention (PCI).
Methods: Prospective, single-arm clinical feasibility study including 100 consecutive patients with multivessel disease undergoing staged HCR. The primary endpoint was the major adverse cardiac and cerebrovascular event rate at 1 year. Secondary endpoints included 1-year all-cause death, stroke, myocardial infarction, repeat revascularization, and angiographic graft and stent patency.
Results: One-year clinical follow-up data were available in all patients. The primary endpoint was met by 20 patients (20%). Individual endpoints were as follows: 1 death due to heart failure; 1 stroke, 2 procedure-related myocardial infarctions; and 1 spontaneous myocardial infarction during follow-up. A total of 16 patients underwent repeat revascularization: 5 surgical reinterventions during the index hospitalization for angiographically suspected internal mammary artery graft dysfunction, and 3 repeat PCIs. Only 1 patient had evidence of ischemia. After discharge, PCI was performed in 6 patients who had recurrent angina, and in 2 asymptomatic patients who had angiographic restenosis. At the 1-year angiographic follow-up, 87 of 89 (98%) patients had patent internal mammary artery grafts. Angiographic restenosis was present in 10 of 100 lesions treated by PCI.
Conclusions: Angiographically controlled HCR was associated with a high repeat revascularization rate. The 1-year 98% LIMA-graft patency rate, and low risk of death and stroke, seem promising for the long-term outcome. Non-left anterior descending coronary artery lesion revascularization remains a challenge.
Trial registration: ClinicalTrials.gov NCT01496664.
Keywords: coronary artery bypass grafting; coronary revascularization; hybrid coronary revascularization; percutaneous coronary intervention.
Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Source: PubMed