Abstract 2277: Major Adverse Events after Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass
Hybrid coronary revascularization is offered as an interventional alternative for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to coronary bypass grafting. Ninety-one patients with multivessel CAD underwent closed-chest left internal mammary artery to left anterior descending (LAD) grafting in combination with percutaneous coronary intervention (PCI) of non-LAD targets (HYBRID). Propensity scoring was used to adjust for potential selection bias. Major Adverse Cardiac and Cerebrovascular Events (MACCE) in the HYBRID group were compared to 4175 contemporaneously performed off-pump coronary artery bypass (OPCAB) operations via logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. The SF-36 survey was used to make quality of life (QOL) comparisons between the HYBRID group and historical data. The 30-day MACCE (death/stroke/non-fatal MI) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (Odds Ratio = 0.47, p = 0.48). Angiographic LIMA evaluation was obtained in 95.6% of patients (87/91) revealing FitzGibbon A patency in 98.0% (96/98). The re-intervention rate at one year for the HYBRID group was 4.4% (4/91) and was limited to repeat PCI. Long-term survival was statistically similar for the two groups (Hazard Ratio = 0.44, p = 0.18, see K-M figure⇓). The groups were similar in all SF-36 QOL subscales. Hybrid coronary revascularization appears to be at least non-inferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.