Hybrid coronary revascularisation; 10-year clinical outcomes of the prospective randomised study

Published in congress: EuroPCR 2024

Hazırlayan: Dr. Yücel Kanal

Introduction:
The HYBRID study suggests that hybrid coronary revascularization (HCR) may be feasible in patients with multivessel coronary artery disease referred for coronary artery bypass grafting (CABG) instead of traditional CABG. The 10-year data of the study, previously presented with 5-year data, have been published.

Method:
This study is prospective, single-center, and open-labeled. A total of 200 patients with multivessel coronary artery disease referred for conventional surgical revascularization were randomized to HCR or CABG. 102 patients were in the CABG group, and 98 patients were in the HCR group. The primary endpoint was all-cause mortality at 10 years. Secondary endpoints included myocardial infarction (MI), stroke, repeat revascularization (PCI or CABG), and MACE (annual all-cause mortality, stroke, repeat revascularization, MI).

Results:
There were no significant differences in demographic and procedural data between the two groups. All-cause mortality was significantly lower in the HCR group compared to the CABG group (20.4% vs. 36.3%; p=0.02). There were no significant differences between the two groups in terms of MI, repeat revascularization, stroke, and MACE endpoints.

Conclusions:
According to the results of this study, the 10-year all-cause mortality rate of patients undergoing HCR is significantly lower than that of patients undergoing traditional CABG. There were no differences between the two groups in terms of MI, stroke, repeat revascularization, and MACE. This suggests that multicenter, larger studies are needed to definitively evaluate the absolute benefits and risks of HCR.

Commentary:
In patients with multivessel disease, the left anterior descending (LAD) artery is commonly used with the left internal mammary artery (LIMA) in CABG, while saphenous vein grafts (SVG) are typically used for other vessels. The patency rate of SVGs at 10 years is reported to be approximately 50%. Following LIMA-LAD grafting with a 10-year patency rate of approximately 98% in CABG, redirecting patients to a hybrid approach may potentially be beneficial in terms of allowing for minimally invasive surgery and shortening procedure times. Given the high patency rates of new-generation drug eluting stents, HCR may potentially be more beneficial in terms of mortality. This study's results also highlight this potential. Supported by larger-scale, multicenter studies, it could influence daily practice.