Abstract 16985: Comparison of 30 Days Outcomes of Coronary Artery Bypass Surgery vs. Hybrid Coronary Revascularization Stratified by Syntax and Euro Scores
Background: CABG offers superior outcomes, especially in diabetics and in patients with complex coronary anatomy, primarily due to the LIMA-LAD graft, while PCI with DES appear to have lower failure rates compared to saphenous vein grafts. Thus, hybrid coronary revascularization (HCR) by combining the LIMA-LAD graft with DES may offer superior results compared to sole CABG or sole PCI. This study analyzes 30 days safety outcomes of traditional CABG vs. HCR, stratified by coronary anatomy (SYNTAX score) and patient risk profile (EURO score).
Methods: 358 consecutive patients (247 CABG and 112 HCR) were stratified by SYNTAX and/or EURO scores. The composite endpoint of death from any cause, stroke, myocardial infarction, or low cardiac output syndrome as well as secondary endpoints of worsening post procedural renal function and bleeding complications during 30 days after the procedures were analyzed.
Results: The preoperative characteristics were similar in the two groups except that patients in the HCR group were older (p=0.006) and had more acute MI (p=0.001) compared to the CABG group (in the high SYNTAX/EURO sub-score group). Rates of the composite adverse endpoint in CABG vs. HCR at 30 days were similar in low, intermediate, or high SYNTAX score groups. Similarly, composite endpoints in CABG vs. HCR were not different in patients with low vs. high EURO score. However, when combined EURO and SYNTAX subgroups were further stratified, patients with both high EURO and high SYNTAX scores showed marked differences in 30 days composite outcomes (0% in CABG vs. 40% in HCR, p=0.02) (Fig.1). Analysis of post procedural renal function and bleeding complications showed similar results across all groups.
Conclusions: Hybrid coronary revascularization is safe in the majority of patients with multi-vessel CAD. However,high-risk patients (combined high SYNTAX and high EURO scores) with complex CAD experience greater safety benefit from traditional CABG compared to HCR.
- © 2010 by American Heart Association, Inc.