Hybrid coronary revascularization versus PCI for the treatment of high-risk patients with multivessel coronary artery disease: 2-year follow-up results from two institutions

Abstract Background The treatment strategies of multivessel coronary artery disease (MV-CAD) encompass drug therapy, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and hybrid coronary revascularization (HCR). Although HCR combines the excellent patency of the left internal mammary artery (LIMA) to the left anterior descending (LAD) graft with the low restenosis rates of drug-eluting stent to non-LAD lesions, its clinical application remains restricted, and its development is not as expected. There is a paucity of research comparing HCR and PCI in high-risk patients with MV-CAD. Consequently, in the current context, the superiority of HCR compared with PCI for high-risk patients with MV-CAD remains uncertain. Purpose The aim of this study is to compare the efficacy of HCR and PCI in the treatment of high-risk patients with MV-CAD. Methods Over a 2-year period, 109 patients underwent HCR and 221 patients underwent PCI were enrolled at two centers. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) (i.e., death, stroke, myocardial infarction, repeat revascularization and angina pectoris symptom) at 2-year follow-up. The Kaplan-Meier Survival curve was utilized to compare the overall survival time between patients who underwent HCR and PCI. Statistical analyses ware performed using SPSS version 30 (IBM, Armonk, NY, USA). Results In the HCR group, there were 72 participants (66.1% male) with an average age of 63.12±8.31 years. In the PCI group, there were 148 participants (67% male) with an average age of 62.44±9.29 years. There was no significant difference in mean SYNTAX score between the two groups (32.52±5.59 vs. 32.38±4.96, P values = 0.81). The mean hospital stay and postoperative intensive care unit time in the HCR group were significantly longer than those in the PCI group (22.64±6.64 vs. 7.93±3.15 days, 48 vs. 24 hours, P values ＜0.01). The average total hospitalization costs in the HCR group were higher than those in the PCI group (13.72±3.85 vs. 6.27±3.07 ten thousand yuan, P values 0.001). There were no significant differences in the incidences of MACCE at 3-month and 1-year follow-up between the two groups. At 2-year follow-up, the angina pectoris symptom rate in the HCR group was significantly lower than that in the PCI group (5.5% vs. 17.2%, P values = 0.003), and the MACCE rate in the HCR group was also lower (12.8% vs. 23.5%, P values = 0.02). Conclusions For high-risk patients with MV-CAD, although HCR shows suboptimal economic efficiency, it is superior to PCI in reducing the MACCE rate at 2-year, mainly attributed to the reduction of angina pectoris events.