Abstract 15829: Hybrid Coronary Revascularization versus Multivessel Pci-Stenting: A Propensity Match Analysis

Abstract

Introduction: Despite current guidelines and the proven LIMA-LAD superiority, PCI-stenting is still largely performed in patients with multi-vessel coronary disease (MVD). Hypothesis: We investigated the role of hybrid revascularization (HCR) meaning MIDCAB combined with PCI as a planned strategy and compared it with PCI alone in patients with multi-vessel coronary disease involving proximal LAD. Methods: We retrospectively analyzed 605 patients with MVD: 179 hybrid and 426 multi-vessel PCI revascularizations. All patients have been discussed within the heart team, based on pre-operative risk (Logistic EuroSCORE II) and on coronary lesions complexity (SYNTAX score). A propensity score matching has been performed and 127 patients from each series selected. Early results were evaluated, and survival analysis for all-causes mortality, cardiac death and MACCE were performed. Results: One-hundred forty-two patients (142/254) had two-vessel disease and 78/254 (41 HCR and 37 PCI patients) had left main involvement. 28 LAD total occlusion in HCR and 18 in PCI groups. 20 PCI patients had recent STEMI and 25 HCR patients. Mean SYNTAX score was 27.5±3.5 and 27±4.0 in HCR and PCI (p=0.8) respectively. No hospital mortality was reported. Overall survival rate at 60 months was (HCR 95% CI: 84.8%, 80.6-91% vs PCI 78.7%, 72.1-85.3%, p=0.23). Freedom from cardiac death survival rate at 60 months was (HCR 95% CI: 91.4%, 85.8-97% vs PCI 84.5%, 78.1-90.9%, p=0.33). Freedom from MACCE survival rate at 60 months was better in HCR group than PCI (95% CI: 74.5%, 66.8-82.4% vs 54.4%, 46.6-62.2%, p=0.015). The reduced target vessel revascularization rate in HCR group was due to LAD repeated revascularization in PCI group. Conclusions: Hybrid Coronary revascularization is a safe and effective strategy to achieve a complete revascularization in patients with multi-vessel disease. HCR, reducing SYNTAX score when due to LAD lesions and the number of stents used to complete revascularization, improved results of PCI-stenting in patients with MVD providing a significantly better freedom from MACCE at mid-term.