Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS) (original) (raw)
Related papers
Journal of the American College of Cardiology, 2013
Beijing, China Objectives This study sought to compare midterm clinical outcomes of 1-stop hybrid coronary revascularization (HCR) with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease. Background One-stop HCR has emerged to be a feasible and attractive alternative to CABG and PCI in selected patients with multivessel coronary artery disease. Methods From June 2007 to December 2010, 141 consecutive patients underwent 1-stop HCR at Fuwai Hospital. Using propensity score methodology, these patients were matched with 2 separate groups of 141 patients who underwent isolated CABG or PCI during the same period. All patients were stratified by the EuroSCORE (European System for Cardiac Operative Risk Evaluation Score) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score. Cutoffs for EuroSCORE (low, 2; medium, >2 and <6; high, !6) and SYNTAX score (low, 24; medium, >24 and <30; high, !30) were identified by tertiles. Three groups' cumulative major adverse cardiac or cerebrovascular events (MACCE) rates in each risk tertile were compared. Results One-stop HCR incurred MACCE rate lower than that with PCI (p < 0.001), but similar to that with CABG (p ¼ 0.140). After stratification by EuroSCORE or SYNTAX score, the cumulative MACCE rates were similar among the 3 groups in low and medium tertiles. But in the high EuroSCORE tertile, patients who underwent 1-stop HCR had a lower MACCE rate than did the groups that underwent CABG (p ¼ 0.030) and PCI (p ¼ 0.006). Meanwhile, patients with a high SYNTAX score who underwent 1-stop HCR had a MACCE rate lower than did those who underwent PCI (p ¼ 0.002), but similar to that of those who underwent CABG (p ¼ 0.362). Conclusions One-stop HCR provides favorable midterm outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with high EuroSCORE or SYNTAX score, it might provide a promising alternative to CABG and PCI.
2021
OBJECTIVE Hybrid coronary revascularization (HCR) combines a minimally invasive surgical approach to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) for non-LAD diseased coronary arteries. It is associated with shorter hospital lengths of stay and recovery times than conventional coronary artery bypass surgery, but there is little information comparing it to isolated PCI for multivessel disease. Our objective is to compare long-term outcomes of HCR and PCI for patients with multivessel disease. METHODS This cohort study used data from New York’s cardiac surgery and PCI registries in 2010−2016 to examine mortality and repeat revascularization rates for patients with multivessel coronary artery disease who underwent HCR and PCI. Cox proportional hazards methods were used to reduce selection bias. Patients were followed for a median of four years. RESULTS There was a total of 335 HCR patients (1.2%) and 25,557 PCI patients (98.8%) after exclusion...
Circulation, 2012
Background— The importance of complete revascularization remains unclear and contradictory. This current investigation compares the effect of complete revascularization on 10-year survival of patients with stable multivessel coronary artery disease (CAD) who were randomly assigned to percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Methods and Results— This is a post hoc analysis of the Second Medicine, Angioplasty, or Surgery Study (MASS II), which is a randomized trial comparing treatments in patients with stable multivessel CAD, and preserved systolic ventricular function. We analyzed patients who underwent surgery (CABG) or stent angioplasty (PCI). The survival free of overall mortality of patients who underwent complete (CR) or incomplete revascularization (IR) was compared. Of the 408 patients randomly assigned to mechanical revascularization, 390 patients (95.6%) underwent the assigned treatment; complete revascularization was achieved in 224 p...
Archives of cardiovascular diseases
Hybrid revascularization, comprising coronary artery bypass graft with exclusive arterial conduits followed by early drug-eluting stent implantation, in multivessel coronary artery disease Revascularisation coronaire hybride combinant pontage « exclusivement artériel » et implantation précoce de stent actif chez les patients multi-tronculaires Summary Aim. -To assess the feasibility and safety of a hybrid myocardial revascularization strategy combining ''exclusive arterial'' conventional coronary artery bypass grafting (CABG) followed by early drug-eluting stent (DES) implantation in multivessel coronary artery disease (CAD). Methods. -Eighteen consecutive patients with multivessel CAD were enrolled prospectively. Within 48 hours of CABG using left internal mammary artery (IMA) to left anterior descending (LAD) coronary artery with or without right IMA to non-LAD vessel in an open chest approach, DESs were implanted systematically in an additional vessel after a clopidogrel 300-mg preloading Abbreviations: CABG, coronary artery bypass graft; CAD, coronary artery disease; DES, drug-eluting stent; IMA, internal mammary artery; LAD, left anterior descending; MIDCAB, minimally invasive direct coronary artery bypass; PCI, percutaneous coronary intervention; RE-MIDCAB, robotically enhanced minimally invasive direct coronary artery bypass; VG, vein graft; RCA, right coronary artery; CPB, cardiopulmonary bypass; MACE, major adverse cardiac events; MI, myocardial infarction; TVR, target vessel revascularization; CK, creatinine kinase; ULN, upper limit of normal; TIMI, thrombolysis in myocardial infarction.
Hybrid Coronary Revascularization for the Treatment of Multivessel Coronary Artery Disease
Journal of the American College of Cardiology, 2016
BACKGROUND-Hybrid coronary revascularization (HCR) combines minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery with percutaneous coronary intervention (PCI) of non-left anterior descending vessels. HCR is increasingly used to treat multivessel coronary artery disease that includes stenoses in the proximal left anterior descending artery and at least 1 other vessel, but its effectiveness has not been rigorously evaluated. OBJECTIVES-This National Institutes of Health-funded, multicenter, observational study was conducted to explore the characteristics and outcomes of patients undergoing clinically indicated
The American Journal of Cardiology, 2010
The aim of this study was to compare clinical outcome at 5 years in patients with complete and incomplete revascularization treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents. Baseline and procedural angiograms and surgical case-record forms were centrally assessed for completeness of revascularization. Patients treated with PCI for incomplete revascularization were stratified according to Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYN-TAX) score tertiles. Complete revascularization was achieved in 360 of 588 patients (61.2%) in the PCI with sirolimus-eluting stent group and 477 of 567 patients (84.1%) in the CABG group (p <0.05). There was no significant difference in 5-year survival without major adverse cardiac and cerebrovascular events (MACCEs; death, cerebrovascular accident, myocardial infarction, and any revascularization) between patients with complete and incomplete revascularization treated with PCI or CABG. Survival free from MACCEs in patients with incomplete revascularization treated with PCI was significantly lower than those with complete revascularization treated with CABG (hazard ratio 1.66, 0.96 to 1.80, log-rank p ؍ 0.001). The 5-year MACCE-free survival in patients with incomplete revascularization treated with PCI stratified according to SYNTAX score tertiles showed a significantly lower MACCE survival in the higher SYNTAX tertile compared to the low (hazard ratio 0.56, 0.32 to 0.96, log-rank p ؍ 0.04) and intermediate (hazard ratio 0.50, 0.28 to 0.91, log-rank p ؍ 0.02) tertiles, whereas survival between the low and intermediate SYNTAX tertiles was not significantly different (hazard ratio 1.13, 0.60 to 2.13, log-rank p ؍ 0.71). In conclusion, this study suggests that patients with complex coronary disease, in whom complete revascularization cannot be achieved with PCI, should be offered surgical revascularization. However, in those patients with less complex disease, PCI is a valid alternative even if complete revascularization cannot be achieved.
Coronary artery revascularization evaluation--a multicenter registry with seven years of follow-up
Journal of the American Heart Association, 2013
Data from randomized clinical trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, in which there is off-label usage of drug-eluting stents (DES). We undertook a prospective registry of coronary revascularization by CABG on- and off-pump and PCI with bare-metal stents (BMSs), DESs, or percutaneous transluminal coronary angioplasty (PTCA) to determine clinical outcomes. All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Final follow-up was obtained after 5 years by patient and/or physician contact and the Social Security Death Index. ST-elevation myocardial infarction and salvage patients were excluded. Five or more years of follow-up was obtained on 81.5% (3156) of the eligible patients-968 CABG patients (82.0%) and 2188 PCI patients (81.3%). Overall follow-up was 63.5±27.9 months (median, 79.7 months). The incidence of initial ...
2013
The "hybrid" approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.
Lancet, 2002
Background Results of trials, comparing percutaneous transluminal coronary angioplasty (PTCA) with coronary artery bypass grafting (CABG), indicate that rates of death or myocardial infarction are similar with either treatment strategy. Management with PTCA is, however, associated with an increased requirement for subsequent, additional revascularisation. Coronary stents, used as an adjunct to PTCA, reduce restenosis and the need for repeat revascularisation. The aim of the Stent or Surgery (SoS) trial was to assess the effect of stent-assisted percutaneous coronary intervention (PCI) versus CABG in the management of patients with multivessel disease. Methods In 53 centres in Europe and Canada, symptomatic patients with multivessel coronary artery disease were randomised to CABG (n=500) or stent-assisted PCI (n=488). The primary outcome measure was a comparison of the rates of repeat revascularisation. Secondary outcomes included death or Q-wave myocardial infarction and all-cause mortality. Analysis was by intention to treat. Findings All patients were followed-up for a minimum of 1 year and the results are expressed for the median follow-up of 2 years. 21% (n=101) of patients in the PCI group required additional revascularisation procedures compared with 6% (n=30) in the CABG group (hazard ratio 3•85, 95% CI 2•56-5•79, p<0•0001). The incidence of death or Q-wave myocardial infarction was similar in both groups (PCI 9% [n=46], CABG 10% [n=49]; hazard ratio 0•95, 95% CI 0•63-1•42, p=0•80). There were fewer deaths in the CABG group than in the PCI group (PCI 5% [n=22], CABG 2% [n=8]; hazard ratio 2•91, 95% CI 1•29-6•53, p=0•01). Interpretation The use of coronary stents has reduced the need for repeat revascularisation when compared with previous studies that used balloon angioplasty, though the rate remains significantly higher than in patients managed with CABG. The apparent reduction in mortality with CABG requires further investigation.