Korean J Thorac Cardiovasc Surg.  2017 Aug;50(4):247-254. 10.5090/kjtcs.2017.50.4.247.

Comparison of Coronary Artery Bypass Graft-First and Percutaneous Coronary Intervention-First Approaches for 2-Stage Hybrid Coronary Revascularization

• Choi HJ
• Kang J
• Song H
• Kim DY
• Choi KB

• KMID: 2387910
• DOI: http://doi.org/10.5090/kjtcs.2017.50.4.247

Abstract

BACKGROUND
Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches.
METHODS
Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion.
RESULTS
No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376).
CONCLUSION
There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.

Keyword

Coronary artery disease; Coronary artery bypass surgery; Percutaneous coronary intervention; Hybrid operation

MeSH Terms

Coronary Artery Bypass*
Coronary Artery Disease
Coronary Vessels*
Hemorrhage
Humans
Incidence
Percutaneous Coronary Intervention
Retrospective Studies
Transplants