Staged hybrid and endovascular myocardial revascularization: 10-year clinical outcomes
Authors:
Company: St. George Thoracic and Cardiovascular Surgery Clinic of the Federal State Budgetary Institution “National Medical and Surgical Center named after N.I. Pirogov”, Moscow, Russian Federation
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Type: Original articles
DOI:
For citation: Shevchenko Yu.L., Borshchev G.G., Ermakov D.Yu., Ulbashev D.S., Vakhrameeva A.Yu. Staged hybrid and endovascular myocardial revascularization: 10-year clinical outcomes. Creative Cardiology. 2024; 18 (4): 426–436 (in Russ.). DOI: 10.24022/1997-3187-2024-18-4-426-436
Received / Accepted: 04.06.2024 / 08.07.2024
Keywords: staged hybrid revascularization coronary heart disease percutaneous coronary intervention
Abstract
Aim – to compare the efficacy and safety of staged hybrid myocardial revascularization (HCR) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease.
Material and methods. The study included 307 patients with coronary heart disease on a retrospective basis, who underwent staged HCR (group I, 152 patients) and PCI (group II, 155 patients) from 2010 to 2017 at the St. George Thoracic and Cardiovascular Surgery Clinic of the N.I. Pirogov National Medical and Surgical Center. The median follow- up period was 122 (84–136) months. The primary combined endpoint of the study was adverse cardiovascular events (MACCE): death from all causes, MI, and stroke. Secondary endpoints (elements of MACCE): death from all causes, MI, stroke, repeat revascularization (any coronary arteries), repeat revascularization of the anterior descending artery.
Results. Staged HCR provides better long-term results compared to PCI alone in terms of MACCE at 10-year follow-up – 62 (40.8%) vs. 82 (52.9%); OR 0.61; 95% CI 0.39–0.96, p = 0.03, and leads to a statistically significantly lower rate of repeat anterior descending artery revascularization compared to endovascular correction alone – 9 (5.9%) vs. 21 (13.5%); OR 0.4; 95% CI 0.18–0.9; p = 0.03.
Conclusion. Staged timing shows greater efficiency and safety in comparison with PCI in the long-term 10-year follow-up period: the hybrid approach provides a statistically significantly lower number of MACCE (MI, stroke, all-cause death) and results in a lower need for repeat revascularization of the LAD.
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About Authors
- Yuriy L. Shevchenko, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, President and Scientific Director; orcid.org/0000-0001-7473-7572
- Gleb G. Borshchev, Dr. Med. Sci., Associate Professor, Cardiovascular Surgeon, Rector of the Institute of Advanced Medical Training; orcid.org/0000-0002-8332-7521
- Dmitry Yu. Ermakov, Cand. Med. Sci., Cardiovascular Surgeon, Doctor of X-ray Endovascular Diagnostics and Treatment; orcid.org/0000-0002-8479-8405
- Daniil S. Ulbashev, Cand. Med. Sci., Cardiovascular Surgeon, Doctor of X-ray Endovascular Diagnostics and Treatment; orcid.org/0000-0003-3288-8414
- Anastasia Yu. Vakhrameeva, Cand. Med. Sci., Radiologist of the Highest Category, Doctor of Functional Diagnostics; orcid.org/0000-0003-2429-3015