Authors
Shevchenko Yu.L.1, Ermakov D.Y.1, Vakhrameeva A.Yu.1, Baranov A.V.2
1 St. George thoracic and cardiovascular surgery clinic Pirogov National Medical and Surgical Center, Moscow
2 Medical school of the Derzhavin Tambov State University, Tambov
Abstract
Background: Staged hybrid coronary revascularization (HCR) is an effective treatment method for patients with CAD. At the moment, the optimal procedure for performing the surgical and endovascular stages of intervention within the framework of HCR in patients with atherosclerotic lesions of the coronary artery (CA) has not been determined.
Purpose: To compare the immediate and long-term results of staged HCR in the scope of coronary artery bypass grafting (CABG) with previous CA stenting and PCI followed by CABG.
Methods: On a retrospective basis, the study included 97 patients with CAD who underwent staged HCR at the Pirogov Center (Moscow, Russia) from 2014 to 2020. In group I, 48 patients underwent CABG followed by PCI (CABG+PCI); in group II, 49 patients first underwent coronary artery stenting, then CABG (PCI+CABG). The average time interval between the 1st and 2nd stages of breastfeeding was 87.5±10.6 days, the total observation period was 36.9±5.8 months.
Results: The CABG+PCI cohort showed slightly better 3-year outcomes compared to the PCI+CABG cohort in terms of relapse of myocardial ischemia (20.1% vs. 24.5%, p = NS) and TLR (18.5% vs. 22.3 %, p = NS). The number of registered cases of VGF in patients of groups I and II was similar — 23.1% versus 24.0% (p = NS). The incidence of MI, stroke, death from all causes did not differ significantly in both groups and was 3 (6.3%), 2 (4.2%) and 3 (6.1%), and 3 (6.1%), 3 (6.3%) and 2 (4.1%) cases in cohorts I and II, respectively (p = NS). The overall proportion of MACE after 36.9±5.8 months of follow-up was 16.7% versus 16.3% in patients with CABG+PCI and PCI+CABG (p = NS).
Conclusion: The approach to HCR with CABG performed as the first stage before PCI shows slightly greater effectiveness and provides similar safety compared to the “PCI before CABG” strategy.
Keywords: сoronary heart disease, hybrid coronary revascularization, coronary artery bypass grafting, percutaneous coronary intervention.
References
1. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(3): 18-114. doi: 10.1161/CIR.0000000000001038.
2. Thuijs DJ, Kappetein AP, Serruys PW, Mohr FW, et al. SYNTAX Extended Survival Investigators. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet. 2019; 394(10206): 1325-1334. doi: 10.1016/S0140-6736(19)31997-X.
3. Brener SJ, Alapati V, Chan D, Da-Wariboko A, Kaid Y, Latyshev Y, et al. The SYNTAX II Score Predicts Mortality at 4 Years in Patients Undergoing Percutaneous Coronary Intervention. J Invasive Cardiol. 2018; 30(8): 290-294.
4. Ganyukov VI, Kochergin NA, Shilov AA, Tarasov RS, Kozyrin KA. Prokudina ES, et al. Randomized Clinical Trial of Hybrid vs. Surgical vs. Percutaneous Multivessel Coronary Revascularization: 5‑year Follow-up of HREVS Trial. Kardiologiia. 2023; 63(11): 57-63. (In Russ.) doi: 10.18087/cardio.2023.11.n2475.
5. Shevchenko YuL, Borshchev GG, Ulbashev DS, Zemlyanov AV. Сhoice of conduits in coronary surgery. Bulletin of Pirogov national medical and surgical Center. 2019; 14 (1): 97-104. (In Russ.) doi: 10.25881/BPNMSC.2019.69.57.019.
6. Shevchenko YuL, Ermakov DY, Marchak DI. Dysfunction of coronary bypass grafts and stents after surgical myocardial revascularization in patients with coronary artery disease: pathogenesis, risk factors and clinical assessment. Bulletin of Pirogov national medical and surgical Center. 2022; 17 (3): 94-100. (In Russ.) doi: 10.25881/20728255_2022_17_3_94.
7. Algoet M, Oosterlinck W, Balkhy HH. Reply to: Anaortic With No Touch to the Aorta Is a Central Technique to Decrease Invasiveness of CABG. Innovations (Phila). 2023; 18(3): 296. doi: 10.1177/15569845231168615.
8. Nenna A, Nappi F, Spadaccio C, et al. Hybrid coronary revascularization in multivessel coronary artery disease: a systematic review. Future Cardiol. 2022; 18(3): 219-234. doi: 10.2217/fca-2020-0244.
9. Hannan EL, Wu Y, Cozzens K, Sundt TM, et al. Hybrid Coronary Revascularization Versus Conventional Coronary Artery Bypass Surgery: Utilization and Comparative Outcomes. Circ Cardiovasc Interv. 2020; 13(10): e009386. doi: 10.1161/CIRCINTERVENTIONS.120.009386.
10. Giambruno V, Jones P, Khaliel F, Chu MW, et al. Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting. Ann Thorac Surg. 2018; 105(5): 1330-1335. doi: 10.1016/j.athoracsur.2017.11.019.
