Hybrid Coronary Revascularization has Improved Short-term Outcomes but Worse Mid-term Reintervention Rates Compared to CABG: A Propensity Matched Analysis

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Abstract

Objective

We evaluated short-term outcomes and mid-term survival and reintervention of hybrid coronary revascularization versus conventional coronary artery bypass grafting using a propensity score matched cohort.

Methods

We conducted a retrospective review of patients undergoing surgery for multivessel coronary artery disease from 2007 to 2015 at a single institution. Patients were propensity matched 1:1 to receiving hybrid coronary revascularization or conventional bypass grafting by multivariate logistic regression on preoperative characteristics. Short-term outcomes were compared. Freedom from reintervention and death were assessed by Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression.

Results

Propensity score matching selected 91 patients per group from 91 hybrid and 2601 conventionally revascularized patients. Hybrid revascularization occurred with surgery first in 56 (62%), percutaneous intervention first in 32 (35%), and simultaneously in 3 (3%) patients. Median intervals between interventions were 3 and 36 days for surgery first and percutaneous intervention first, respectively. Preoperative characteristics were similar. Patients undergoing hybrid revascularization had shorter postoperative length of stay (median = 4 vs 5 days, P < 0.001), less postoperative transfusion (13.2% vs 34.1%, P = 0.001), and respiratory failure (0% vs 6.6%, P = 0.03). They were more likely to be discharged home (93.4% vs 71.4%, P < 0.001), with no difference in 30-day mortality (P = 0.99), readmission (P = 0.23), or mid-term survival (P = 0.79). Hybrid revascularization was associated with earlier reintervention (P = 0.02). Hazard ratios for reintervention and patient mortality of hybrid coronary revascularization versus conventional revascularization were 3.60 (95% confidence interval = 1.16–11.20) and 1.17 (95% confidence interval = 0.37–3.72), respectively.

Conclusions

Despite having favorable short-term outcomes and similar survival, hybrid coronary revascularization may be associated with earlier reintervention compared with conventional techniques.

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