Hybrid Coronary Revascularization Is Associated With Improved Short Term Outcomes But Worse Mid-Term Re-intervention Rates Compared To Conventional CABG: A Propensity Matched Analysis
Yu Xia, Abraham Katz, Stephen Forest, Robert Pyo, Mark Greenberg, Joseph DeRose, Jr..
Montefiore Medical Center, Bronx, NY, USA.
OBJECTIVE: Hybrid coronary revascularization (HCR) using minimally invasive LIMA-LAD revascularization and PCI is an attractive alternative to conventional CABG, but data comparing the two are limited and may not adequately adjust for comorbidities. We evaluated outcomes following HCR and conventional CABG using a propensity matched cohort.
METHODS: We conducted retrospective review of CABG and HCR patients from 2007-2015 at a single institution. Patients were propensity matched 1:1 to receiving HCR versus CABG by multivariable logistic regression on age, gender, ejection fraction, peripheral vascular disease, cerebrovascular disease, COPD, diabetes, dialysis, and number of vessels requiring revascularization. In-hospital and 30 day outcomes were compared. Freedom from reintervention and death were assessed by the Kaplan Meier method with log-rank test and univariable Cox proportional hazards regression.
RESULTS: From an initial cohort of 91 HCR and 2601 conventional CABG patients, 91 patients in each group were selected after propensity score matching. HCR was performed with surgery first in 56(62%), PCI first in 32(35%), and simultaneously in 3(3%) patients. Median interval between interventions was 3(IQR 3-6) and 36(IQR 30-50) days for surgery first and PCI first, respectively. HCR and conventional CABG patients had similar preoperative characteristics. HCR patients had shorter post-operative length of stay [median (IQR) 4(3-6) vs 5(4-8), p<0.001] and lower incidence of post-operative transfusion (13.2% vs 34.1%, p=0.001) and respiratory failure(0% vs 6.6%, p=0.03). HCR patients were more likely to be discharged home (93.4% vs 71.4%, p<0.001). There was no significant difference in 30-day mortality(p=0.99) or readmission(p=0.23). HCR was significantly associated with more re-intervention(log-rank p=0.02, Fig 1) while overall survival was not significantly different(log-rank p=0.79). The hazard ratio for re-intervention and patient mortality of HCR compared to CABG were 3.60 (95% CI 1.16-11.20) and 1.17 (95% CI 0.37-3.72), respectively.
CONCLUSIONS: Despite having favorable short term outcomes and similar survival compared to CABG, HCR may be associated with higher rates of repeat revascularization. Prospective studies to confirm these findings are warranted.
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