HYBRID: Hybrid Revascularization Shows Safety, Effectiveness vs. CABG in Multivessel CAD

San Francisco, CA—Compared with CABG, hybrid coronary revascularization is safe and feasible in selected patients with multivessel CAD, according to results from the first randomized pilot study of the revascularization technique, which combines minimally invasive bypass surgery with percutaneous coronary intervention (PCI). Michal Hawranek, MD, PhD, of the Silesian Center for Heart Diseases in Zabrze, Poland, presented the data Thursday at TCT 2013.

In the HYBRID trial, patients with angiographically-confirmed multivessel CAD suitable for both PCI and CABG were randomly assigned to hybrid coronary revascularization (n=100) or surgery (n=100).  The hybrid procedure was completed in two stages and combined minimally invasive direct coronary artery bypass (MIDCAB) from the left internal mammary artery (LIMA) to the LAD with PCI using a DES. According to Hawranek, the goal was to perform both procedures in 36 hours. 

Feasibility, safety demonstrated

Feasibility, a primary endpoint, was high in both groups with less than 10% conversion to surgery (see Figure). The percentage of patients free from MACE (composite of death, MI, stroke, TVR or major bleeding) within 12 months, the coprimary endpoint, did not differ significantly between the surgery and hybrid  groups (92.2% vs. 89.8%). Additionally, there was no incidence of stroke in either group, and the rate of death was similar (2.9% vs. 2.0%). TVR occurred in 2.0% of patients in the hybrid group vs. 0% with CABG, and the rate of MI was 6.1% in the hybrid group vs. 3.9% in the CABG group.

One-third of patients had diabetes, and baseline characteristics were similar between the groups. Angiographic and procedural characteristics were also similar. In-hospital outcomes did not differ between the two groups; there was one case of renal failure requiring dialysis in the hybrid group, and the length of stay was nearly 9 days (CABG, 8.9 ± 5.6 days vs. hybrid, 8.8 ± 4.3).

At the time of angiographic follow-up, more than 80% of grafts were patent in both groups. 

“MIDCAB as a first-stage procedure in patients with multivessel disease considered for hybrid revascularization was not associated with more adverse events,” Hawranek concluded.

He and his colleagues plan to assess quality of life and cost-effectiveness in future analyses.  

Disclosures:

Hawranek reports receiving consultant fees/honoraria from Balton.