One-stop hybrid coronary revascularization versus coronary artery bypass grafting and percutaneous coronary intervention for the treatment of multivessel coronary artery disease: 3-year follow-up results from a single institution

Abstract

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 = 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 = 0.030) and PCI (p = 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 = 0.002), but similar to that of those who underwent CABG (p = 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.