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The authors present the 5-year follow-up results of the HYBRID trial, wherein 200 patients with multivessel disease requiring revascularization were randomized to either conventional coronary artery bypass grafting (CABG) or hybrid coronary revascularization (HCR). Notably, the patients undergoing HCR had a LIMA to LAD via a minimally invasive approach combined with percutaneous coronary intervention (PCI) of the remaining vessels.
The following table summarizes the results from this trial:
Outcome CABG HCR p-value
All-cause mortality 9.2% 6.4% 0.69
Myocardial infarction 7.2% 3.4% 0.30
Repeat revascularization 45.4% 37.2% 0.38
Stroke 4.1% 2.1% 0.35
MACCE 53.4% 45.2% 0.39
The authors conclude that there were no differences in outcomes between the two types of revascularization.
Comment: Although none of the differences achieved statistical significance, there does appear to be a trend for better outcomes with HCR. The lack of significance may be related to inadequate power of the study to detect a difference.
Question: Is it not time to rethink our approach to HCR? Most centers are approaching the procedure with a minimally invasive approach using a single mammary artery. If our main concern is outcomes—as it should be—is it not time to reassess HCR as a conventional or minimally invasive procedure utilizing both LIMA and RIMA for appropriate targets, and PCI for the rest? This would seem to be the optimal approach, so that the patient gets the true benefit of both worlds: the superiority of bilateral mammary revascularization over any alternative conduits, and the superiority of PCI over SVG. What do you think?
